Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Diagnostic efficacy of endoscopic ultrasound-guided needle sampling for upper gastrointestinal subepithelial lesions: a meta-analysis

  • 577 Accesses

  • 25 Citations



An increasing number of studies have been conducted on the use of endoscopic ultrasound (EUS)-guided needle sampling for upper gastrointestinal subepithelial lesions (SEL). However, reported diagnostic efficacy varies greatly.


To summarize up current evidences on the diagnostic efficacy of EUS-guided needle sampling for upper GI SEL.


A reproducible strategy was used to search four databases. Search results were evaluated for eligibility, and the quality of eligible studies was assessed by QUADAS-2. Pooled efficacy of EUS-guided needle sampling in upper GI SEL was calculated. Procedure-related complications, diagnostic errors, and independent factors related to a higher success rate were also recorded and analyzed.


Seventeen studies, comprising 978 attempts of EUS-guided needle sampling, were included in a meta-analysis. Pooled diagnostic rate of EUS-guided needle sampling was 59.9 %, with a heterogeneity I 2 of 55.2 %. Subgroup analysis showed no difference in diagnostic rate among fine needle aspiration (FNA), trucut needle biopsy (TCB), and fine needle biopsy (FNB), or among 19-, 22-, and 25-G needles. Subgroup analysis and meta-regression suggested that the cell block method might be correlated with a higher diagnostic rate. Few severe complications were reported. Diagnosis errors were rare.


EUS-guided needle sampling is a safe, but only moderately effective method for pathology diagnosis of upper GI SEL. Choice of FNA/TCB/FNB, or 19 G/22 G/25 G does not seem to alter the overall diagnostic rate.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Hwang JH, Saunders MD, Rulyak SJ, Shaw S, Nietsch H, Kimmey MB (2005) A prospective study comparing endoscopy and EUS in the evaluation of GI subepithelial masses. Gastrointest Endosc 62(2):202–208 (Epub 2005/07/28)

  2. 2.

    Demetri GD, von Mehren M, Antonescu CR, DeMatteo RP, Ganjoo KN, Maki RG et al (2010) NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Canc Netw JNCCN 8(Suppl 2):S1–S41 (quiz S2-4. Epub 2010/05/18)

  3. 3.

    Yoshinaga S, Suzuki H, Oda I, Saito Y (2011) Role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for diagnosis of solid pancreatic masses. Dig Endosc 23:29–33

  4. 4.

    Polkowski M, Bergman JJ (2010) Endoscopic ultrasonography-guided biopsy for submucosal tumors: Needless needling? Endoscopy 42(4):324–326 (Epub 2010/04/01)

  5. 5.

    Ando N, Goto H, Niwa Y, Hirooka Y, Ohmiya N, Nagasaka T et al (2002) The diagnosis of GI stromal tumors with EUS-guided fine needle aspiration with immunohistochemical analysis. Gastrointest Endosc 55(1):37–43 (Epub 2002/01/05)

  6. 6.

    Vander Noot MR, Eloubeidi MA, Chen VK, Eltoum I, Jhala D, Jhala N et al (2004) Diagnosis of gastrointestinal tract lesions by endoscopic ultrasound-guided fine-needle aspiration biopsy. Cancer 102(3):157–163 (Epub 2004/06/24)

  7. 7.

    Philipper M, Hollerbach S, Gabbert HE, Heikaus S, Bocking A, Pomjanski N et al (2010) Prospective comparison of endoscopic ultrasound-guided fine-needle aspiration and surgical histology in upper gastrointestinal submucosal tumors. Endoscopy 42(4):300–305 (Epub 2010/03/23)

  8. 8.

    Fernandez-Esparrach G, Sendino O, Sole M, Pellise M, Colomo L, Pardo A et al (2010) Endoscopic ultrasound-guided fine-needle aspiration and trucut biopsy in the diagnosis of gastric stromal tumors: a randomized crossover study. Endoscopy 42(4):292–299 (Epub 2010/04/01)

  9. 9.

    Ji JS, Lee BI, Choi KY, Kim BW, Choi H, Huh M et al (2009) Diagnostic yield of tissue sampling using a bite-on-bite technique for incidental subepithelial lesions. Korean J Intern Med 24(2):101–105

  10. 10.

    Lee CK, Chung IK, Lee SH, Lee TH, Park SH, Kim HS et al (2010) Endoscopic partial resection with the unroofing technique for reliable tissue diagnosis of upper GI subepithelial tumors originating from the muscularis propria on EUS (with video). Gastrointest Endosc 71(1):188–194 (Epub 2009/11/03)

  11. 11.

    de la Serna-Higuera C, Perez-Miranda M, Diez-Redondo P, Gil-Simon P, Herranz T, Perez-Martin E et al (2011) EUS-guided single-incision needle-knife biopsy: description and results of a new method for tissue sampling of subepithelial GI tumors (with video). Gastrointest Endosc 74(3):672–676 (Epub 2011/08/30)

  12. 12.

    Kim JH, Chung JW, Ha M, Rim MY, Lee JJ, An J et al (2013) A feasible modified biopsy method for tissue diagnosis of gastric subepithelial tumors. World J Gastroenterol WJG 19(29):4752–4757 (Epub 2013/08/08)

  13. 13.

    Binmoeller KF, Shah JN, Bhat YM, Kane SD (2013) Retract-ligate-unroof-biopsy: a novel approach to the diagnosis and therapy of large nonpedunculated stromal tumors (with video). Gastrointest Endosc 77(5):803–808 (Epub 2013/02/02)

  14. 14.

    Cantor MJ, Davila RE, Faigel DO (2006) Yield of tissue sampling for subepithelial lesions evaluated by EUS: a comparison between forceps biopsies and endoscopic submucosal resection. Gastrointest Endosc 64(1):29–34 (Epub 2006/07/04)

  15. 15.

    Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB et al (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155(8):529–536 (Epub 2011/10/19)

  16. 16.

    Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558 (Epub 2002/07/12)

  17. 17.

    Fleiss JL (1993) The statistical basis of meta-analysis. Stat Methods Med Res 2(2):121–145 (Epub 1993/01/01)

  18. 18.

    Mavridis D, Salanti G (2014) How to assess publication bias: funnel plot, trim-and-fill method and selection models. Evid Based Ment Health 17(1):30 (Epub 2014/01/31)

  19. 19.

    Kim GH, Cho YK, Kim EY, Kim HK, Cho JW, Lee TH et al (2014) Comparison of 22-gauge aspiration needle with 22-gauge biopsy needle in endoscopic ultrasonography-guided subepithelial tumor sampling. Scand J Gastroenterol 49(3):347–354 (Epub 2013/12/12)

  20. 20.

    Akahoshi K, Oya M, Koga T, Koga H, Motomura Y, Kubokawa M et al (2014) Clinical usefulness of endoscopic ultrasound-guided fine needle aspiration for gastric subepithelial lesions smaller than 2 cm. J Gastrointestin Liver Dis JGLD 23(4):405–412 (Epub 2014/12/23)

  21. 21.

    Eckardt AJ, Adler A, Gomes EM, Jenssen C, Siebert C, Gottschalk U et al (2012) Endosonographic large-bore biopsy of gastric subepithelial tumors: a prospective multicenter study. Eur J Gastroenterol Hepatol 24(10):1135–1144 (Epub 2012/07/17)

  22. 22.

    Watson RR, Binmoeller KF, Hamerski CM, Shergill AK, Shaw RE, Jaffee IM et al (2011) Yield and performance characteristics of endoscopic ultrasound-guided fine needle aspiration for diagnosing upper GI tract stromal tumors. Dig Dis Sci 56(6):1757–1762 (Epub 2011/03/02)

  23. 23.

    Suzuki T, Arai M, Matsumura T, Arai E, Hata S, Maruoka D et al (2011) Factors associated with inadequate tissue yield in EUS-FNA for gastric SMT. ISRN Gastroenterol 2011:619128 (Epub 2011/10/13)

  24. 24.

    Lee JH, Choi KD, Kim MY, Choi KS, Kim DH, Park YS et al (2011) Clinical impact of EUS-guided Trucut biopsy results on decision making for patients with gastric subepithelial tumors >/= 2 cm in diameter. Gastrointest Endosc 74(5):1010–1018 (Epub 2011/09/06)

  25. 25.

    Iglesias-Garcia J, Poley JW, Larghi A, Giovannini M, Petrone MC, Abdulkader I et al (2011) Feasibility and yield of a new EUS histology needle: results from a multicenter, pooled, cohort study. Gastrointest Endosc 73(6):1189–1196 (Epub 2011/03/23)

  26. 26.

    DeWitt J, Emerson RE, Sherman S, Al-Haddad M, McHenry L, Cote GA et al (2011) Endoscopic ultrasound-guided Trucut biopsy of gastrointestinal mesenchymal tumor. Surg Endosc 25(7):2192–2202 (Epub 2010/12/25)

  27. 27.

    Camellini L, Carlinfante G, Azzolini F, Iori V, Cavina M, Sereni G et al (2011) A randomized clinical trial comparing 22 G and 25 G needles in endoscopic ultrasound-guided fine-needle aspiration of solid lesions. Endoscopy 43(8):709–715 (Epub 2011/05/26)

  28. 28.

    Mekky MA, Yamao K, Sawaki A, Mizuno N, Hara K, Nafeh MA et al (2010) Diagnostic utility of EUS-guided FNA in patients with gastric submucosal tumors. Gastrointest Endosc 71(6):913–919 (Epub 2010/03/17)

  29. 29.

    Yoshida S, Yamashita K, Yokozawa M, Kida M, Takezawa M, Mikami T et al (2009) Diagnostic findings of ultrasound-guided fine-needle aspiration cytology for gastrointestinal stromal tumors: proposal of a combined cytology with newly defined features and histology diagnosis. Pathol Int 59(10):712–719 (Epub 2009/10/01)

  30. 30.

    Polkowski M, Gerke W, Jarosz D, Nasierowska-Guttmejer A, Rutkowski P, Nowecki ZI et al (2009) Diagnostic yield and safety of endoscopic ultrasound-guided trucut [corrected] biopsy in patients with gastric submucosal tumors: a prospective study. Endoscopy 41(4):329–334 (Epub 2009/04/03)

  31. 31.

    Imazu H, Uchiyama Y, Kakutani H, Ikeda K, Sumiyama K, Kaise M et al (2009) A prospective comparison of EUS-guided FNA using 25-gauge and 22-gauge needles. Gastroenterol Res Pract 2009:546390 (Epub 2009/12/10)

  32. 32.

    Hoda KM, Rodriguez SA, Faigel DO (2009) EUS-guided sampling of suspected GI stromal tumors. Gastrointest Endosc 69(7):1218–1223 (Epub 2009/04/28)

  33. 33.

    Arantes V, Logrono R, Faruqi S, Ahmed I, Waxman I, Bhutani MS (2004) Endoscopic sonographically guided fine-needle aspiration yield in submucosal tumors of the gastrointestinal tract. J Ultrasound Med 23(9):1141–1150 (Epub 2004/08/26)

  34. 34.

    Park YS, Park SW, Kim TI, Song SY, Choi EH, Chung JB et al (2004) Endoscopic enucleation of upper-GI submucosal tumors by using an insulated-tip electrosurgical knife. Gastrointest Endosc 59(3):409–415 (Epub 2004/03/05)

  35. 35.

    Lee IL, Lin PY, Tung SY, Shen CH, Wei KL, Wu CS (2006) Endoscopic submucosal dissection for the treatment of intraluminal gastric subepithelial tumors originating from the muscularis propria layer. Endoscopy 38(10):1024–1028 (Epub 2006/10/24)

  36. 36.

    Karaca C, Turner BG, Cizginer S, Forcione D, Brugge W (2010) Accuracy of EUS in the evaluation of small gastric subepithelial lesions. Gastrointest Endosc 71(4):722–727 (Epub 2010/02/23)

  37. 37.

    Nishida T, Kawai N, Yamaguchi S, Nishida Y (2013) Submucosal tumors: comprehensive guide for the diagnosis and therapy of gastrointestinal submucosal tumors. Dig Endosc 25(5):479–489 (Epub 2013/08/02)

  38. 38.

    Dumonceau JM, Polkowski M, Larghi A, Vilmann P, Giovannini M, Frossard JL et al (2011) Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 43(10):897–912 (Epub 2011/08/16)

  39. 39.

    Iglesias-Garcia J, Dominguez-Munoz JE, Abdulkader I, Larino-Noia J, Eugenyeva E, Lozano-Leon A et al (2011) Influence of on-site cytopathology evaluation on the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of solid pancreatic masses. Am J Gastroenterol 106(9):1705–1710

  40. 40.

    Mondoni M, Carlucci P, Di Marco F, Rossi S, Santus P, D’Adda A et al (2013) Rapid on-site evaluation improves needle aspiration sensitivity in the diagnosis of central lung cancers: a randomized trial. Respiration 86(1):52–58 (Epub 2013/04/19)

  41. 41.

    Witt BL, Schmidt RL (2013) Rapid onsite evaluation improves the adequacy of fine-needle aspiration for thyroid lesions: a systematic review and meta-analysis. Thyroid 23(4):428–435 (Epub 2012/10/10)

  42. 42.

    Eloubeidi MA, Tamhane A (2008) Prospective assessment of diagnostic utility and complications of endoscopic ultrasound-guided fine needle aspiration. Results from a newly developed academic endoscopic ultrasound program. Dig Dis 26(4):356–363 (Epub 2009/02/04)

  43. 43.

    Liu W, Sun S, Ge N, Wang S, Liu X, Wang G et al (2012) Rupture of a duodenal stromal tumor during EUS-FNA: a case report. Endosc Ultrasound 1(1):53–55 (Epub 2012/04/01)

  44. 44.

    Inoue H, Mizuno N, Sawaki A, Takahashi K, Aoki M, Bhatia V et al (2006) Life-threatening delayed-onset bleeding after endoscopic ultrasound-guided 19-gauge Trucut needle biopsy of a gastric stromal tumor. Endoscopy 38(Suppl 2):E38 (Epub 2007/03/17)

Download references


This study was supported by the grants from the Major Project of Shanghai Municipal Science and Technology Committee (11411950502 and 13411950801), Academic Leader Training Project of Shanghai Municipal+ Commission of Health and Family Planning (13B038), National Natural Science Foundation of China (81302098, 81201902, 81470811, and 81401930), and Natural Science Foundation of Shanghai (13ZR1452300). No other financial relationships relevant to this publication were disclosed. We appreciate the effort of statistician Hui-Xun Jia, from Clinical Statistics Center, Fudan University Shanghai Cancer Center, in reviewing statistical methods used in this paper.

Author information

Correspondence to Ping-Hong Zhou.

Ethics declarations


Xiao-Cen Zhang, Quan-Lin Li, Yong-Fu Yu, Li-Qing Yao, Mei-Dong Xu, Yi-Qun Zhang, Yun-Shi Zhong, Wei-Feng Chen, and Ping-Hong Zhou have no conflicts of interest or financial ties to disclose.

Additional information

Dr. Xiao-Cen Zhang and Dr. Quan-Lin Li have contributed equally to this work.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Zhang, X., Li, Q., Yu, Y. et al. Diagnostic efficacy of endoscopic ultrasound-guided needle sampling for upper gastrointestinal subepithelial lesions: a meta-analysis. Surg Endosc 30, 2431–2441 (2016). https://doi.org/10.1007/s00464-015-4494-1

Download citation


  • Endosonography
  • Biopsy, needle
  • Diagnosis
  • Subepithelial lesion