DOI: 10.1177/17562848261458692 ISSN: 1756-2848

Impact of wet suction on specimen quality and diagnostic accuracy in EUS-guided tissue acquisition: a systematic review and meta-analysis of randomized controlled trials

Po-Feng Huang, Jung-Chun Lin, Tien-Yu Huang, Peng-Jen Chen, Chi-Wei Yang, Yu-Ting Kuo, Hsuan-Wei Chen
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Background and aims:

Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is critical for diagnosing solid lesions. The wet-suction technique, which pre-fills the needle lumen with saline, has been proposed to improve specimen quality compared with conventional dry suction. This study aimed to evaluate the efficacy of wet suction versus dry suction in EUS-TA.

Objectives:

This study aimed to evaluate the efficacy of wet suction versus dry suction in EUS-TA.

Design:

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) following PRISMA 2020 guidelines.

Methods:

Electronic searches of PubMed, Embase, Cochrane CENTRAL, and additional databases were performed through January 2025. Primary outcomes were blood contamination, cellularity, and integrity scores; secondary outcomes were diagnostic accuracy and specimen adequacy. Effect sizes were calculated using Hedges’ g or risk ratios (RRs) with 95% confidence intervals (CIs).

Results:

Seven RCTs (784 patients; 1566 specimens) were included. Wet suction significantly reduced blood contamination (Hedges’ g  = 0.289, 95% CI: 0.178–0.401, p  < 0.0001) and improved cellularity (Hedges’ g  = 0.420, 95% CI: 0.241–0.599, p  < 0.0001) with low heterogeneity. Integrity score showed no significant difference ( p  = 0.054). Overall diagnostic accuracy was similar between techniques (RR = 1.025, p  = 0.548), but subgroup analysis revealed higher accuracy for wet suction in EUS-fine needle aspiration (FNA; RR = 1.162, p  = 0.001). Specimen adequacy did not differ significantly ( p  = 0.074).

Conclusion:

Wet suction improves sample quality by reducing blood contamination and increasing cellularity, with potential diagnostic benefit in FNA procedures. Effects on integrity and adequacy remain inconclusive. Larger, standardized trials are warranted to confirm these findings.

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