Clin Endosc.  2022 Sep;55(5):637-644. 10.5946/ce.2021.257.

Comparison of diagnostic performances of slow-pull suction and standard suction in endoscopic ultrasound-guided fine needle biopsy for gastrointestinal subepithelial tumors

  • 1Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
  • 2Department of Pathology, Kyungpook National University School of Medicine, Daegu, Korea


Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is integral to the diagnosis of gastrointestinal (GI) subepithelial tumors (SETs). The impact of different EUS-FNB tissue sampling techniques on specimen adequacy and diagnostic accuracy in SETs has not been fully evaluated. This study aimed to compare the diagnostic outcomes of slow-pull (SP) and standard suction (SS) in patients with GI SETs.
In this retrospective comparative study, 54 patients were enrolled. Medical records were reviewed for location and size of the target lesion, FNB needle type/size, technical order, specimen adequacy, diagnostic yield, and adverse events. The acquisition rate of adequate specimens and diagnostic accuracy were compared according to EUS-FNB techniques.
The mean lesion size was 42.6±36.4 mm, and most patients were diagnosed with GI stromal tumor (75.9%). The overall diagnostic accuracies of the SP and SS techniques were 83.3% and 81.5%, respectively (p=0.800). The rates of obtaining adequate core tissue were 79.6% and 75.9%, respectively (p=0.799). No significant clinical factors affected the rate of obtaining adequate core tissue, including lesion location and size, FNB needle size, and final diagnosis.
SP and SS had comparable diagnostic accuracies and adequate core tissue acquisition for GI SETs via EUS-FNB.


Endosonography; Fine-needle biopsy; Gastrointestinal stromal tumors; Subepithelial tumor; Tissue acquisition


  • Fig. 1. The flow-chart of this study. EUS, endoscopic ultrasound; TS, tissue sampling; GI, gastrointestinal; SET, subepithelial tumor; SP, slow-pull suction; SS, standard suction.

  • Fig. 2. Representative images of the measured tumor area. (A) Gastrointestinal stromal tumor in the gastric corpus. (B) Leiomyoma in the esophagus.

  • Fig. 3. The comparison of adequate core-tissue acquisition rate based on tissue sampling techniques. (A) Lesions located in the stomach. (B) Lesion size. (C) Needle size. (D) Final diagnosis. Others are leiomyoma, schwannoma, paraganglioma, ectopic pancreas. GIST, gastrointestinal stromal tumor.

  • Fig. 4. The comparison of obtaining tumor area based on tissue sampling techniques. (A) Lesions located in the stomach. (B) Lesion size. (C) Needle size. (D) Final diagnosis. Others are leiomyoma, schwannoma, paraganglioma, and ectopic pancreas. GIST, gastrointestinal stromal tumor.

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Clin Endosc. 2023;56(6):744-753.    doi: 10.5946/ce.2023.005.


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