BACKGROUND:This is a randomized study to compare the diagnostic accuracy of endoscopic ultrasound (EUS)-guided sampling of pancreatic solid lesions obtained with the 22-gauge Franseen (EUS-fine needle biopsy) vs the 22-gauge standard needle (EUS-fine needle aspiration) without rapid onsite evaluation (ROSE), since, in most endoscopy units around the world ROSE is not routinely available. AIM:To investigate the accuracy of EUS-guided sampling of pancreatic solid lesions obtained between two different needles without ROSE. METHODS:Patients with a solid pancreatic were included. Patients were biopsied in a randomized order. The primary endpoint was the diagnostic sensitivity for pancreatic malignancy (PM). Secondary outcomes were adequacy of the sample, the mean tissue area, the mean tumor area, and the adverse event rate. RESULTS:The final diagnosis was pancreatic adenocarcinoma in 38 (76%), neuroendocrine tumor in 4 (8%), chronic pancreatitis in 3 (6%) patients. The sensitivity for PM with Franseen needle was 0.91 [95% confidence interval (CI): 0.80-0.98], vs 0.8 (95%CI: 0.67-0.91) (P = 0.025) with standard needle. The specificity for PM did not differentiate. The accuracy of the standard needle for PM was 0.80 (95%CI: 0.66-0.90), and the Franseen group was 0.90 (95%CI: 0.78-0.97) (P = 0.074). The technical success rates for the standard and Franseen needle groups were 94% (95%CI: 0.83-0.99) and 100% (95%CI: 0.92-1.00), respectively. The mean total tissue area in mm2 (SD) was greater in the Franseen group, 2.07 (0.22) vs 1.16 (0.17) (P < 0.01). The mean tumor area in mm2 (SD) was not different in Franseen group vs standard group, 0.42 (0.09) vs 0.47 (0.09) (P = 0.80). There were no adverse events. CONCLUSION:The sensitivity for PM and mean total tissue area, was greater in the as compared with standard needle. The mean tumor area did not differ between the groups.

Spencer Cheng: YES financial relationship with a commercial interest;Boston Scientific :Consulting | Sérgio Matuguma: NO financial relationship with a commercial interest | Guilherme Henrique Peixoto de Oliveira: NO financial relationship with a commercial interest | Gustavo Silva: NO financial relationship with a commercial interest | Henrique Cheng: NO financial relationship with a commercial interest | Mauricio Minata: NO financial relationship with a commercial interest | Sergio A. Sánchez-Luna: YES financial relationship with a commercial interest;2021 American Society for Gastrointestinal Endoscopy (ASGE) Endoscopic Training Award by the ASGE and Fujifilm:Grant/Research Support

BACKGROUND: Curvilinear array ultrasound transducers enable tissue sampling and have therapeutic capabilities. Nevertheless, colonic intubation and maneuvering with these transducers is technically challenging and is therefore typically limited to the rectosigmoid area. This retrospective cohort study aimed to evaluate the safety, feasibility, and diagnostic yield of colonoscopic ultrasound-guided fine-needle aspiration in deep colonic intubation. IMPACT OF INNOVATION: The impact of this innovation is to enable tissue sampling of colonic and extracolonic lesions guided by endoscopic ultrasound. TECHNOLOGY, MATERIALS, AND METHODS: Curvilinear array ultrasound is used in the evaluation of luminal and extraluminal colonic diseases. Thirteen patients underwent colonoscopic ultrasound with a curvilinear array ultrasound endoscope in a single center for subepithelial lesions, cancer staging, and extracolonic lesions from July 2015 to February 2021. Endosonography was performed using an Olympus EU-ME1 and GF-UCT 180 with a 5-12MHz curvilinear array transducer. The primary outcome was the percentage of patients who were successfully scanned with the endoscopic ultrasound. The secondary outcomes included the success rate of fine-needle aspiration, the diagnostic yield of the tissue samples, and the adverse events related to the procedure. PRELIMINARY RESULTS: A total of 13 female patients underwent colonoscopic ultrasound. All patients (100%, 13/13) were successfully scanned. Fine-needle aspiration was deemed necessary and successfully performed in 100% (5/5) of the patients. Tissue samples collected by fine-needle aspiration resulted in a diagnostic yield of 60%, and no adverse events resulted from this intervention. CONCLUSIONS: This study demonstrates the feasibility of performing colonoscopic ultrasound with a curvilinear array transducer. Fine-needle aspiration for subepithelial, colonic, and extracolonic lesions is feasible and safe in this setting with no adverse events reported in our study. FUTURE DIRECTIONS: Future research should be directed toward validating colonoscopic ultrasound with a curvilinear array transducer technique in prospective randomized trials. Studies evaluating the feasibility and safety of endoscopic ultrasound-guided interventions in the colon, such as abscess drainage and enteral anastomosis, should be considered.

previous studies evaluate magnification endoscopy (ME) and correlate changes on the gastric mucosal surface with Helicobacter pylori (Hp) infection.

The use of lumen-apposing metal stent (LAMS) for drainage of pancreatic fluid collections (PFCs) has gained increasing popularity because of high clinical and technical success. It is supposed that LAMS has lower risk of migration since it has two large flanges with antimigratory features. However, there is lack of robust data supporting this advantage over conventional biliary covered self-expanding metal stents (CSEMS), which is also effective and safe. Therefore, the aim of this study is to compare LAMS versus CSEMS to evaluate migration rates. This is an ongoing randomized, controlled, open label trial in a tertiary therapeutic endoscopy center. Only symptomatic patients or patients with infected PFCs have been recruited. Interim analysis is presented. Characteristics of the initial 25 patients enrolled are summarized in table 1. Thirteen subjects were randomized to CSEMS and 12 for LAMS with no statistical difference between the groups. Technical success was not achieved in only two cases of LAMS (100% vs 83.3%; p=0.78), due to stent misdeployment. Both cases were successfully treated with placement of a CSEMS through the malpositioned LAMS. There was one mild adverse event (bleeding), in a procedure using LAMS. Necrosectomy or lavage of the cavity were necessary in 12 PFCs, six in each group. Accidental displacement of the stent occured in two necrosectomies. Stent migration was detected in only one subject of the CSEMS arm (p=1.0). Despite the considerable amount of articles addressing the use of LAMS in PFCs, its superiority is still conflicting in a few aspects. Some centers reported that the indication should be carefully reviewed by multidisciplinary opinion and based on the characteristics of the patient. To our knowledge, this is the first trial assessing migration as primary outcome. Our interim analysis suggests that stent migration was not different comparing LAMS and CSEMS. However, LAMS can be less cumbersome to access the collection for necrosectomy.

Lumen-apposing metal stents (LAMSs) have been widely used for drainage of pancreatic fluid collections (PFCs) [1]. However, misplacement of stents is not rare and demands immediate intervention. We describe the use of a biliary selfexpandable metal stent (SEMS) placed through the LAMS to address misplacement during an endoscopic ultrasound (EUS)-guided drainage procedure. In the first case, a 24-year-old woman presenting with a symptomatic PFC (▶Fig. 1) after an episode of moderate acute pancreatitis was referred for EUSguided drainage. During deployment of the LAMS (3 cm×12–15mm; Hanarostent; Mitech), we accidentally released the proximal flange into the gastric wall. We pulled the stent towards the gastric lumen using a foreign body forceps, but the distal flange detached from the collection, dissecting the retroperitoneum (▶Fig. 2). We therefore placed a guidewire into the PFC through the LAMS using a pediatric endoscope. Finally, we deployed a biliary fully-covered SEMS (10mm×6cm; Hanarostent; Mitech) to connect the PFC to the stomach (▶Video1). Both stents were removed a month later without complications. In the second case, a 50-year-old man presenting with a symptomatic walledoff necrosis (▶Fig. 3) after a severe episode of pancreatitis was referred for EUS-guided drainage. During the procedure, the proximal flange was accidentally deployed into the gastric wall (▶Fig. 4). Under EUS guidance, we introduced the sheath of the needle and a guidewire through the LAMS into the PFC. We deployed a fully-covered biliary SEMS inside the LAMS, thereby creating a communication between the PFC and the stomach (▶Fig. 5). Both stents were removed at 1-month follow-up without complications. E-Videos

For palliation of malignant biliary obstruction (MBO), the gold-standard method of biliary drainage is endoscopic retrograde cholangiopancreatography (ERCP) with the placement of metallic stents. Endoscopic ultrasound (EUS)-guided drainage is an alternative that is typically reserved for cases of ERCP failure. Recently, however, there have been robust randomized clinical trials (RCTs) comparing EUS-guided drainage and ERCP as primary approaches to MBO.To compare EUS guidance and ERCP in terms of their effectiveness and safety in palliative biliary drainage for MBO.This was a systematic review and meta-analysis, in which we searched the MEDLINE, Excerpta Medica, and Cochrane Central Register of Controlled Trials databases. Only RCTs comparing EUS and ERCP for primary drainage of MBO were eligible. All of the studies selected provided data regarding the rates of technical and clinical success, as well as the duration of the procedure, adverse events, and stent patency. We assessed the risk of biases using the Jadad score and the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation criteria.The database searches yielded 5920 records, from which we selected 3 RCTs involving a total of 222 patients (112 submitted to EUS and 110 submitted to ERCP). In the EUS and ERCP groups, the rate of technical success was 91.96% and 91.81%, respectively, with a risk difference (RD) of 0.00% (95%CI: -0.07, 0.07; P = 0.97; I2 = 0%). The clinical success was 84.81% and 85.53% in the EUS and ERCP groups, respectively, with an RD of -0.01% (95%CI: -0.12, 0.10; P = 0.90; I2 = 0%). The mean difference (MD) for the duration of the procedure was -0.12% (95%CI: -8.20, 7.97; P = 0.98; I2 = 84%). In the EUS and ERCP groups, there were 14 and 25 adverse events, respectively, with an RD of -0.06% (95%CI: -0.23, 0.12; P = 0.54; I2 = 77%). The MD for stent patency was 9.32% (95%CI: -4.53, 23.18; P = 0.19; I2 = 44%). The stent dysfunction rate was significantly lower in the EUS group (MD = -0.22%; 95CI:-0.35, -0.08; P = 0.001; I2 = 0%).EUS represents an interesting alternative to ERCP for MBO drainage, demonstrating lower stent dysfunction rates compared with ERCP. Technical and clinical success, duration, adverse events and patency rates were similar.

The retrograde biliary drainage using metallic stents through ERCP is currently the gold-standard method in a palliative setting of malignant biliary obstruction (MBO). The EUS-guided drainage is an alternative route but usually left for ERCP failure cases. Recently, however, robust randomized clinical trials (RCTs) comparing EUS-guided drainage to ERCP as a primary approach of MBO have been published. Thus, we aimed to compare the effectiveness and safety of EUS-guided and ERCP in this context through a systematic review and meta-analysis of the literature.

Upper gastrointestinal bleeding (UGB) is a common condition but despite advances in clinical and endoscopic treatments, it still carries high mortality rates. Depending on the etiology, several endoscopic therapeutic modalities are suitable as definite treatment. The TC-325 is a novel mineral hemostatic powder that creates a mechanical barrier through absorption of serum fluid components that concentrate clotting. Furthermore, it activates important factors from the coagulation cascade. Several studies have shown promising results of the TC-325 at treating UGB since the first use in humans in 2011. However, such articles are small and the real efficacy and safety profile of the TC-325 still remains unclear.

BACKGROUND For palliation of malignant biliary obstruction (MBO), the gold-standard method of biliary drainage is endoscopic retrograde cholangiopancreatography (ERCP) with the placement of metallic stents. Endoscopic ultrasound (EUS)-guided drainage is an alternative that is typically reserved for cases of ERCP failure. Recently, however, there have been robust randomized clinical trials (RCTs) comparing EUS-guided drainage and ERCP as primary approaches to MBO. AIM To compare EUS guidance and ERCP in terms of their effectiveness and safety in palliative biliary drainage for MBO.METHODS This was a systematic review and meta-analysis, in which we searched the MEDLINE, Excerpta Medica, and Cochrane Central Register of Controlled Trials databases. Only RCTs comparing EUS and ERCP for primary drainage of MBO were eligible. All of the studies selected provided data regarding the rates of technical and clinical success, as well as the duration of the procedure, adverse events, and stent patency. We assessed the risk of biases using the Jadad score and the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation criteria.RESULTS The database searches yielded 5920 records, from which we selected 3 RCTs involving a total of 222 patients (112 submitted to EUS and 110 submitted to ERCP). In the EUS and ERCP groups, the rate of technical success was 91.96% and 91.81%, respectively, with a risk difference (RD) of 0.00% (95% CI: -0.07, 0.07; P = 0.97; I-2 = 0%). The clinical success was 84.81% and 85.53% in the EUS and ERCP groups, respectively, with an RD of -0.01% (95% CI: -0.12, 0.10; P = 0.90; I-2 = 0%). The mean difference (MD) for the duration of the procedure was -0.12% (95% CI: -8.20, 7.97; P = 0.98; I-2 = 84%). In the EUS and ERCP groups, there were 14 and 25 adverse events, respectively, with an RD of -0.06% (95% CI: -0.23, 0.12; P = 0.54; I-2 = 77%). The MD for stent patency was 9.32% (95% CI: -4.53, 23.18; P = 0.19; I-2 = 44%). The stent dysfunction rate was significantly lower in the EUS group (MD = -0.22%; 95CI:-0.35, -0.08; P = 0.001; I-2 = 0%).CONCLUSION EUS represents an interesting alternative to ERCP for MBO drainage, demonstrating lower stent dysfunction rates compared with ERCP. Technical and clinical success, duration, adverse events and patency rates were similar.

Background: Suction (S) is commonly used to improve cell acquisition during endoscopic ultrasoundguided fine-needle aspiration (EUS-FNA). Slow-pull (SP) sampling is another technique that might procure good quality specimens with less bloodiness. We aimed to determine if SP improves the diagnostic yield of EUS-FNA of pancreatic masses. Methods: Patients with pancreatic solid masses were randomized to four needle passes with both techniques in an alternate fashion. Sensitivity, specificity, positive, and negative predictive values were calculated. Cellularity and bloodiness of cytological samples were assessed and compared according to the technique. Results: Sensitivity, specificity, and accuracy of suction vs. SP were 95.2% vs. 92.3%; 100% vs. 100; 95.7% vs. 93%, respectively. As to the association of methods, they were 95.6, 100 and 96%, respectively. Positive predictive values for S and SP were 100%. There was no difference in diagnostic yield between S and SP (p = 0.344). Cellularity of samples obtained with SP and Suction were equivalent in both smear evaluation (p = 0.119) and cell-block (0.980). Bloodiness of SP and suction techniques were similar as well. Conclusions: S and SP techniques provide equivalent sensitivity, specificity, and accuracy. Association of methods seems to improve diagnostic yield. Suction does not increase the bloodiness of samples compared to slow-pull.

Objective: This systematic review and meta-analysis aims to compare surgical and endoscopic treatment for pancreatic pseudocyst (PP). Methods: The researchers did a search in Medline, EMBASE, Scielo/Lilacs, and Cochrane electronic databases for studies comparing surgical and endoscopic drainage of PP s in adult patients. Then, the extracted data were used to perform a meta-analysis. The outcomes were therapeutic success, drainage-related adverse events, general adverse events, recurrence rate, cost, and time of hospitalization. Results: There was no significant difference between treatment success rate (risk difference [RD] -0.09; 95% confidence interval [CI] [0.20,0.01]; P = .07), drainage-related adverse events (RD -0.02; 95% CI [-0.04,0.08]; P = .48), general adverse events (RD -0.05; 95% CI [-0.12, 0.02]; P = .13) and recurrence (RD: 0.02; 95% CI [-0.04,0.07]; P = .58) between surgical and endoscopic treatment. Regarding time of hospitalization, the endoscopic group had better results (RD: -4.23; 95% CI [-5.18, -3.29]; P < .00001). When it comes to treatment cost, the endoscopic arm also had better outcomes (RD: -4.68; 95% CI [-5.43,-3.94]; P < .00001). Conclusion: There is no significant difference between surgical and endoscopic treatment success rates, adverse events and recurrence for PP. However, time of hospitalization and treatment costs were lower in the endoscopic group.

Abstract Background and study aims TC-325 is a novel mineral hemostatic powder that creates a mechanical barrier by absorbing blood components and promoting clotting. Recently approved for use in humans, it has shown promise for treatment of upper gastrointestinal bleeding (UGIB). However, because there have been no large studies of TC-325, its true efficacy and safety profile remain unknown. We performed a systematic review and meta-analysis to determine the safety and efficacy of TC-325 in treating UGIB, based on rates of initial hemostasis, rebleeding, and adverse events (AEs). Methods We searched the MEDLINE/PubMed, EMBASE, CENTRAL, Latin-American and Caribbean Health Sciences Literature databases, as well as the gray literature, to identify articles describing use of TC-325 up to October 2018. Primary outcomes were initial hemostasis and rebleeding. AEs were described as a secondary outcome. Risk of bias was assessed with international scores. Results We identified 2077 records after removal of duplicates. We included 50 studies, involving a collective total of 1445 patients, in the quantitative synthesis. Primary hemostasis and rebleeding rates were 90.7 % and 26.1 %, respectively. Subgroup analyses showed similar results. Only eight AEs were reported. Conclusions TC-325 appears to be a safe, effective treatment for UGIB. The overall rate of initial hemostasis after TC-325 use is high, regardless of etiology of bleeding or whether TC-325 is used as a primary or rescue therapy. Although it is also associated with high rebleeding rates, rates of AEs and equipment failure after TC-325 use are extremely low.

Brazilian case of EUS-guided transmural drainage of a walledoff necrosis with the HOT-AXIOSTM system and to describe the technique for the deployment.

Our aim in this study was to compare the efficiency of 25G versus 22G needles in diagnosing solid pancreatic lesions by EUS-FNA. We performed a systematic review and meta-analysis. Studies were identified in five databases using an extensive search strategy. Only randomized trials comparing 22G and 25G needles were included. The results were analyzed by fixed and random effects. A total of 504 studies were found in the search, among which 4 randomized studies were selected for inclusion in the analysis. A total of 462 patients were evaluated (233: 25G needle/229: 22G needle). The diagnostic sensitivity was 93% for the 25G needle and 91% for the 22G needle. The specificity of the 25G needle was 87%, and that of the 22G needle was 83%. The positive likelihood ratio was 4.57 for the 25G needle and 4.26 for the 22G needle. The area under the sROC curve for the 25G needle was 0.9705, and it was 0.9795 for the 22G needle, with no statistically significant difference between them (p=0.497). Based on randomized studies, this meta-analysis did not demonstrate a significant difference between the 22G and 25G needles used during EUS-FNA in the diagnosis of solid pancreatic lesions.

Objectives The aim of the study was to evaluate the role of early endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of acute biliary pancreatitis, in comparison with conservative treatment. Methods Systematic review via databases (MEDLINE [PubMed], Latin-American and Caribbean Health Sciences Literature database, Embase, Cochrane Central, and the [Brazilian] Regional Library of Medicine) is conducted. We analyzed 10 randomized controlled trials (1091 patients). Outcomes were the following: local and systemic adverse events; acute cholangitis; death; length of hospital stay; cost; abdominal pain; and time to a reduction in body temperature. For the meta-analysis, we used risk difference (RD) and mean with standard deviation as measures of variability. Results There was a statistically significant difference between the patients submitted to ERCP in terms of the following: local adverse events (RD, 0.74; 95% confidence interval [CI], 0.55–0.99), time to pain relief and time to a reduction in axillary temperature (RD, −5.01; 95% CI, −6.98 to −3.04, and RD, −1.70; 95 CI%, −2.33 to −1.08, respectively). Patients undergoing ERCP spent less time in hospital (RD, −11.04; 95% CI, −15.15 to −6.93). Cost was lower in the group treated with ERCP. Conclusions Early ERCP decreases local adverse events, shortening the time to pain relief, to a reduction in axillary temperature, hospital stays, and cost in patients with acute biliary pancreatitis.

Occurrence of metastasis to the gastrointestinal tract (GIT) is rare. The studies on the endoscopic findings of metastatic tumors are usually restricted to small case series. As a consequence of the improved in the survival time for cancer patients over recent years, it is expected that progressively more cancer patients could present for diagnosis, by endoscopy, of secondary tumors of the GIT. With this regard, it would be useful to better characterize the endoscopic aspects of metastases to the GIT. observational study conducted in an oncological referral center between January 2009 and August 2017. The study included patients with metastasis to the GIT, submitted to endoscopic exam (upper gastrointestinal endoscopy, colonoscopy, enteroscopy, endoscopic ultrasound) with histological confirmation. Patients with lymphoma, leukemia, multiple myeloma, Kaposi sarcoma or direct invasion from adjacent organs were excluded. From January 2009 to august 2017, 53.675 endoscopic exams were performed. A total of 184 cases were suspected gastrointestinal metastasis. In 94 patients the diagnosis was confirmed. The baseline characteristics of the patients are summarized in Table 1. Common indications for endoscopy were abdominal pain (29 cases – 30.8%), gastrointestinal bleeding (28 cases – 29.8%) and vomiting (18 cases – 19.1%). The most common site of metastasis was the stomach (60 cases – 59.6%), followed by small bowel (29 cases – 29.8%) and colon (7 cases – 7.4%). Eight patients (8.5%) had metastasis in more than one site in the GIT. As indicated in Table 2, the most common primary malignancy was melanoma (25 cases – 26.6%), followed by breast (14 cases – 14.9%) and lung (14 cases – 14.9%). If considered just the gastric metastasis, the most common primary malignancy was melanoma (17 cases – 28.3%), breast (11 cases - 18.3 %) and lung (7 -11.3%). The most common endoscopic presentation of the metastatic lesions in the stomach was a solitary (32 cases – 53.3 %), ulcerated (31 cases – 51.6%) lesion located in the gastric body (75%). If considered just the small bowel metastasis the most common primary malignancy was lung (7 cases – 24.1%) and melanoma (7 cases – 24.1%) followed by breast (3 cases – 10.4%). The most common endoscopic presentation of the metastatic lesions in small bowel was the presence of a solitary (22 cases 84.6 %), polypoid (10 cases – 38.5%) lesion located in the second portion of duodenum (17 cases – 65.4%). Melanoma, breast and lung cancer were the most common metastasis to the GIT. The stomach was the main site of the metastatic lesions and the most common endoscopic presentation of stomach metastasis was solitary, ulcerated lesions in the gastric body. Despite the rarity of this condition, endoscopists should be aware of this differential diagnosis.Tabled 1Table 1 - Patients CharacteristicsNumber of patientsMale4952.1%Age (years)58.523 - 85Symptoms8388.3 %Dysphagia1111.7 %Weight Loss1313.8 %Bleeding2829.8 %Abdominal pain2930.8 %Nausea or vomiting1819.1 %Jaundice11.1 %Constipation11.1 %Asymptomatic1111.7 %Primary TumorNumber of patient%Head and neck55.3 %Esophagus55.3 %Uterus44.2 %Stomach55.3 %Breast1414.9 %Melanoma2526.6 %Ovary33.2 %Colorectal44.2 %Lung1414.9 %Kidney55.3 %Sarcoma33.2 %Merkel's tumor11.1 %Duodenum11.1 %Indeterminate site11.1 %Hepatocellular11.1 % Open table in a new tab Tabled 1Table 2 – Endoscopic featuresOrganNumber of patients%Esophagus55.3 %Stomach6059.6 %Small Bowel2930.8 %Colorectal77.4 %Number of metastasisNumber of patients%Single6265.6 %2- 4 lesions1617.1 %> 5 lesions1718,1 %Size< 20mm3335.1 %20 - 50mm4042.5 %> 50mm2122.3 %AspectPolypoid2526.6 %Infiltrative2122.3 %Resembling early cancer1010.63 %Subepitelial33.19 %Ulcerated1718.1 %Ulcero-Infiltrative1819.4 % Open table in a new tab

Our aim in this study was to compare the efficiency of 25G versus 22G needles in diagnosing solid pancreatic lesions by EUS-FNA. We performed a systematic review and meta-analysis. Studies were identified in five databases using an extensive search strategy. Only randomized trials comparing 22G and 25G needles were included. The results were analyzed by fixed and random effects. A total of 504 studies were found in the search, among which 4 randomized studies were selected for inclusion in the analysis. A total of 462 patients were evaluated (233: 25G needle/229: 22G needle). The diagnostic sensitivity was 93% for the 25G needle and 91% for the 22G needle. The specificity of the 25G needle was 87%, and that of the 22G needle was 83%. The positive likelihood ratio was 4.57 for the 25G needle and 4.26 for the 22G needle. The area under the sROC curve for the 25G needle was 0.9705, and it was 0.9795 for the 22G needle, with no statistically significant difference between them (p = 0.497). Based on randomized studies, this meta-analysis did not demonstrate a significant difference between the 22G and 25G needles used during EUS-FNA in the diagnosis of solid pancreatic lesions.