Digestive Diseases and Sciences

, Volume 61, Issue 3, pp 890–899 | Cite as

Eliminating the Residual Negative Pressure in the Endoscopic Ultrasound Aspirating Needle Enhances Cytology Yield of Pancreas Masses

  • A. Aziz Aadam
  • Young S. Oh
  • Vinod B. Shidham
  • Abdul Khan
  • Bryan Hunt
  • Nagarjun Rao
  • Ying Zhang
  • Sergey Tarima
  • Kulwinder S. Dua
Original Article



Prior to withdrawing the EUS-FNA needle from the lesion, the stopcock of the suction syringe is closed to reduce contamination. Residual negative pressure (RNP) may persist in the needle despite closing the stopcock.


To determine whether neutralizing RNP before withdrawing the needle will improve the cytology yield.


Bench-top testing was done to confirm the presence of RNP followed by a prospective, randomized, cross-over study on patients with pancreas mass. Ten milliliters of suction was applied to the FNA needle. Before withdrawing the needle from the lesion, the stopcock was closed. Based on randomization, the first pass was done with the stopcock either attached to the needle (S+) or disconnected (S−) to allow air to enter and neutralize RNP and accordingly the second pass was crossed over to S+ or S−. On-site cytopathologist was blinded to S+/S−.


Bench tests confirmed the presence of RNP which was successfully neutralized by disconnecting the syringe (S−) from the needle. Sixty patients were enrolled, 120 samples analyzed. S+ samples showed significantly greater GI tract contamination compared to S− samples (16.7 vs. 6.7 %, p = 0.03). Of the 53 patients confirmed to have pancreas adenocarcinoma, FNA using S− approach was positive in 49 (93 %) compared to 40 using the S+ approach (76 %, p = 0.02).


Despite closing the stopcock of the suction syringe, RNP is present in the FNA needle. Neutralizing RNP prior to withdrawing the needle from the target lesion significantly decreased GI tract contamination of the sample thereby improving the FNA cytology yield.

Clinical Trials Registration Number



Endoscopic ultrasound (EUS) Tissue acquisition Fine needle aspiration (FNA) Pancreas mass Pancreas adenocarcinoma 



Endoscopic ultrasound


Fine needle aspiration


Syringe-on; the suction syringe with its stopcock closed still attached to the needle handle


Syringe-off; the suction syringe with its stopcock closed disconnected from the needle handle

Minus (negative pressure)



This publication was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Number 8UL1TR000055. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

Supplementary material 1 (WMV 49176 kb)

Supplementary material 2 (WMV 26989 kb)


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Digestive DiseasesRush University Medical CenterChicagoUSA
  2. 2.Division of Gastroenterology and Hepatology, Department of MedicineMedical College of WisconsinMilwaukeeUSA
  3. 3.Department of PathologyMedical College of WisconsinMilwaukeeUSA
  4. 4.Department of BiostatisticsMedical College of WisconsinMilwaukeeUSA

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