Comparison of 19-Gauge and 22-Guage needles in EUS-Guided Sampling of Subepithelial lesion and pancreatic tumor : A Study of Diagnostic Efficacy.

Abstract

Background: Endoscopic ultrasound-guided tissue sampling is an important diagnostic procedure for subepithelial lesions and pancreatic tumors. Needle gauge may influence tissue adequacy and diagnostic performance. Objective: To compare the efficacy of tissue acquisition between 19-gauge and 22-gauge needles. Methods: This comparative observational study included 72 patients who underwent endoscopic ultrasound-guided tissue sampling at Lopburi Cancer Hospital between October 1, 2024 and October 30, 2025. Fifteen patients were included in the 19-gauge needle group and 57 in the 22-gauge needle group. Data collected included lesion characteristics, number of needle passes, procedure time, pathological findings, and tissue adequacy. Descriptive statistics were used, and between-group comparisons were performed using Fisher’s exact test. Results: Adequate tissue for diagnosis was obtained in 93.3% of patients in the 19-gauge group and 80.7% in the 22-gauge group, with no statistically significant difference between the groups (OR 3.35, 95% CI 0.40–28.25, P=0.438). The mean procedure time was 31.53±12.45 minutes in the 19-gauge group and 34.67±11.76 minutes in the 22-gauge group, with no statistically significant difference (P=0.291). An additional analysis using a 40-minute cutoff showed a significant difference in the proportion of procedures completed within 40 minutes between the two groups (P=0.028). However, this cutoff was not prespecified in the original analysis plan. Conclusion: The 19-gauge and 22-gauge needles demonstrated comparable efficacy in obtaining adequate tissue for diagnosis. Although the 19-gauge needle showed
a trend toward a higher rate of tissue adequacy and a slightly shorter mean procedure time, the findings do not establish its superiority over the 22-gauge needle. Needle selection should therefore be based on lesion characteristics and location, patient-related factors, and operator experience.