Copyright
©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Push vs pull method for endoscopic ultrasound-guided fine needle aspiration of pancreatic head lesions: Propensity score matching analysis
Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Ko Watanabe, Jun Nakamura, Hitomi Kikuchi, Yuichi Waragai, Mika Takasumi, Minami Hashimoto, Yuko Hashimoto, Takuto Hikichi, Hiromasa Ohira
Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Ko Watanabe, Jun Nakamura, Hitomi Kikuchi, Yuichi Waragai, Mika Takasumi, Minami Hashimoto, Hiromasa Ohira, Department of Gastroenterology, Fukushima Medical University, School of Medicine, Fukushima 960-1247, Japan
Ko Watanabe, Jun Nakamura, Hitomi Kikuchi, Minami Hashimoto, Takuto Hikichi, Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1247, Japan
Yuko Hashimoto, Department of Diagnostic Pathology, Fukushima Medical University, Fukushima 960-1247, Japan
Author contributions: Sugimoto M designed and performed the study; Sugimoto M, Takagi T and Ohira H analyzed the data and wrote the paper; Suzuki R, Konno N, Asama H, Sato Y, Irie H, Watanabe K, Nakamura J, Kikuchi H, Waragai Y, Takasumi M, Hashimoto M and Hikichi T provided clinical advice; Hashimoto Y performed pathological diagnoses; and Hikichi T and Ohira H supervised the study.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Fukushima Medical University.
Informed consent statement: Patients were not required to give informed consent for participation in the study because the analysis used anonymous clinical data obtained after each patient provided written consent agreeing to treatment. For full disclosure, the details of the study are published on the home page of Fukushima Medical University.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tadayuki Takagi, MD, PhD, Associate Professor, Department of Gastroenterology, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima Prefecture 960-1247, Japan. daccho@fmu.ac.jp
Telephone: +81-24-5471202 Fax: +81-24-5472055
Received: May 2, 2018
Peer-review started: May 4, 2018
First decision: May 17, 2018
Revised: June 5, 2018
Accepted: June 25, 2018
Article in press: June 25, 2018
Published online: July 21, 2018
ARTICLE HIGHLIGHTS
Research background
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) plays an important role in the diagnosis of pancreatic cancer. However, EUS-FNA of pancreatic head lesions is difficult. The pull and push methods are both used to diagnose pancreatic head lesions. It is unknown which method is more efficient.
Research motivation
We wanted to determine the appropriate puncture method for EUS-FNA of pancreatic head lesions.
Research objectives
The primary objective of this study was to reveal which method (push method or pull method) is more efficient for diagnosing pancreatic head cancer.
Research methods
We placed 85 patients in each group (push group and pull group) using propensity score matching. Patient characteristics and some EUS-FNA-related factors were compared between the push and pull groups.
Research results
The distance to the pancreatic cancer was significantly longer in the push group than in the pull group. The push method was identified as a significant factor contributing to the histological diagnosis of malignancy.
Research conclusions
The pull method shortened the distance between the echoendoscope and the lesion and facilitated EUS-FNA of pancreatic head cancer. The push method contributed to the histological diagnosis of pancreatic head cancer using EUS-FNA specimens.
Research perspectives
If only a diagnosis of malignancy is needed or if the endoscopist is inexperienced, the pull method is recommended. However, the push method is recommended for patients requiring histological analysis of EUS-FNA specimens. Further prospective and large-scale studies on these methods are warranted.
