Interventional EUS Using a Flexible 19-Gauge Needle: An International Multicenter Experience in 162 Patients

Vivek Kumbhari, Irene Peñas, Alan H. Tieu, Carlos De la Serna-Higuera, Manie Juneja, Fuad Maufa, Saowanee Ngamruengphong, Mohamad H. El-Zein, Nadim Haddad, Sandeep Krishnan, Susana Gonzalez, Peter V. Renny, Payal Saxena, Linda Howard, Christopher J. DiMaio, Jonathan M. Buscaglia, Manuel Perez-Miranda, Mouen A. Khashab

Research output: Contribution to journalArticlepeer-review


Background and Aims: To facilitate access for interventional EUS, flexible (nitinol) 19-G needles have been introduced to permit needle puncture even when the echoendoscope is in an angulated position, such as in the second part of the duodenum. The aims of the study were to evaluate the performance of a flexible 19-G needle during interventional EUS procedures and compare outcomes when the echoendoscope was in the straight versus angulated position. Methods: A retrospective review was undertaken of 162 consecutive patients that underwent a variety of interventional EUS procedures with a flexible 19-G needle across five centers. Patients were subdivided into categories (straight or angulated) depending on the echoendoscope position used for obtaining access to the area of interest (Fig. 1).[Figure not available: see fulltext.] Results: In the entire cohort, needle-specific technical success was achieved in 93.2 %, procedural success in 85.2 %, and overall clinical success in 76.5 % of cases at a mean follow-up of 3.1 months. Needle-specific technical success was similar between the straight and angulated cohorts (94.0 vs. 91.2 %, p = 0.74). Procedural success (86.7 vs. 77.2 %, p = 0.05), and rate of clinical success was similar between the cohorts (83.3 vs. 86.4 %, p = 0.79), respectively. Overall adverse events were noted in 14.2 % of patients with no difference between the straight and angulated cohorts (p = 0.48). Conclusions: This study demonstrates equivalent technical success, clinical success and safety of using a flexible 19-G needle in straight and angulated endoscope positions for interventional EUS. Therefore, a flexible needle may be considered where an angulated echoendoscope position is encountered.

Original languageEnglish (US)
Pages (from-to)3552-3559
Number of pages8
JournalDigestive diseases and sciences
Issue number12
StatePublished - Dec 1 2016


  • Angulated
  • Biliary drainage
  • Drainage
  • Endosonography
  • Flexible 19-G needle
  • Interventional endoscopic ultrasound
  • Pancreatic fluid collection
  • Therapeutic endoscopic ultrasound

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology


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