Feasibility and diagnostic performance of heparinized wetsuction and single-pass single-needle actuation endoscopic ultrasound-guided tissue acquisition for subepithelial lesions in Japan: a single-center retrospective study.

BACKGROUND/AIMS: Heparinized wet suction (HEP) and the single-pass single-needle actuation method (HEP1p1a) are promising for endoscopic ultrasound-guided tissue acquisition (EUS-TA) because they improve specimen quality. However, its applicability in the biopsy of subepithelial lesions (SELs) remains unexamined. Therefore, this study evaluated the clinical utility of EUS-TA using HEP1p1a in SELs. METHODS: This study analyzed data of patients who underwent EUS-TA using HEP1p1a between January 2019 and May 2025. The primary outcome was pathological differentiation. Furthermore, clinical data of EUS-TA using HEP1p1a were compared with those using HEP and other than 1p1a; subgroup analysis was performed comparing the clinical outcomes between SELs ≥20 and <20 mm. RESULTS: Thirty-six patients underwent EUS-TA using HEP1p1a (technical success rate: 100%): 24 and 12 patients with lesions ≥20 and <20 mm, respectively. The rates of achieving pathological differentiation, immunohistochemical success, and definitive histologic diagnosis were 94.4%, 89.3%, and 86.1%, respectively; for SELs ≥20 mm, they were 100%, 94.7%, and 95.8%, respectively. Cellularity and maximum length of white sequential specimens were better in patients with lesions ≥20 mm. No adverse events were observed during or after the procedures. CONCLUSIONS: High diagnostic performance and specimen quality were demonstrated with EUS-TA using HEP1p1a for SELs, particularly those >20 mm. To acquire high-quality specimens while minimizing blood contamination, EUS-TA with HEP1pla for SELs might be an effective approach.