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BACKGROUND: Suction (S) is commonly used to improve cell acquisition during endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Slow-pull (SP) sampling is another technique that might procure good quality specimens with less bloodiness. We aimed to determine if SP improves the diagnostic yield of EUS-FNA of pancreatic masses. METHODS: Patients with pancreatic solid masses were randomized to four needle passes with both techniques in an alternate fashion. Sensitivity, specificity, positive, and negative predictive values were calculated. Cellularity and bloodiness of cytological samples were assessed and compared according to the technique. RESULTS: Sensitivity, specificity, and accuracy of suction vs. SP were 95.2% vs. 92.3%; 100% vs. 100; 95.7% vs. 93%, respectively. As to the association of methods, they were 95.6, 100 and 96%, respectively. Positive predictive values for S and SP were 100%. There was no difference in diagnostic yield between S and SP (p = 0.344). Cellularity of samples obtained with SP and Suction were equivalent in both smear evaluation (p = 0.119) and cell-block (0.980). Bloodiness of SP and suction techniques were similar as well. CONCLUSIONS: S and SP techniques provide equivalent sensitivity, specificity, and accuracy. Association of methods seems to improve diagnostic yield. Suction does not increase the bloodiness of samples compared to slow-pull.

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RESUMO

Objective: Through this systematic review and meta-analysis, we aim to clarify the differences between these two techniques, thus improving primary success cannulation and reducing complications during endoscopic retrograde cholangiopancreatography, primarily pancreatitis. Methods: A comprehensive search was conducted to search for data available up until June2015from the most important databases available in the health field: EMBASE, MEDLINE (via PubMed), Cochrane, LILACS and CENTRAL (via BVS), SCOPUS, the CAPES database (Brazil), and gray literature. Results: Nine randomized clinical trialsincluding2583 people were selected from20,198 studies for meta-analysis. Choledocholithiasis had been diagnosed in mostly (63.8%) of the patients, who were aged an average of 63.15 years. In those patients treated using the guide wire-assisted cannulation technique, provided a significantly lower instance of pancreatitis (RD=0.03; 95% CI: 0.01-0.05; I2= 45%) and greater primary success cannulation (RD=0.07; 95% CI: 0.03-0.12; I2=12%) than conventional contrast cannulation. Conclusions: The guide wire-assisted technique, when compared to the conventional contrast technique, reduces the risk of pancreatitis and increases primary success cannulation rate. Thus, guide wire-assisted cannulation appears to be the most appropriate first-line cannulation technique

Objetivo: A través de esta revisión sistemática y meta-análisis, nuestro objetivo es aclarar las diferencias entre estas dos técnicas, mejorando así la canulación de éxito primario y reducir las complicaciones durante la colangiopancreatografía retrógrada endoscópica, principalmente la pancreatitis. Métodos: Una búsqueda exhaustiva se realizó para buscar datos disponibles hasta junio de 2015, desde las bases de datos más importantes disponibles en el campo de la salud: EMBASE, MEDLINE (vía PubMed), Cochrane, LILACS y CENTRAL (a través de la BVS), SCOPUS, la base de datos CAPES (Brasil), y la literatura gris. Resultados: Nueve ensayos clínicos aleatorios incluyendo 2583 personas fueron seleccionados de 20198 estudios de meta- análisis. Coledocolitiasis había sido diagnosticada en su mayoría (63,8%) de los pacientes, que tenían entre un promedio de 63,15 años. En los pacientes tratados con la técnica de canulación guiada, proporcionado una instancia significativamente menor de pancreatitis (RD=0,03; IC del 95%: 0,01-0,05; I2=45%) y una mayor canalización de éxito primario (RD=0,07; IC del 95%: 0,03-0.12; I2=12%) que la canulación por contraste. Conclusiones: La técnica canulación con alambre guía, en comparación a la técnica de contraste convencional, reduce el riesgo de pancreatitis y aumenta la tasa de canulación con éxito primario. Por lo tanto, canulación con alambre guía parece ser la técnica de canulación de primera línea y la más adecuada

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