Clin Endosc.  2022 Sep;55(5):615-625. 10.5946/ce.2022.133.

Mucosal incision-assisted biopsy versus endoscopic ultrasound-assisted tissue acquisition for subepithelial lesions: a systematic review and meta-analysis

• Giri S
• Afzalpurkar S
• Angadi S
• Sundaram S

• KMID: 2533299
• DOI: http://doi.org/10.5946/ce.2022.133

Abstract

Background/Aims
Mucosal incision-assisted biopsy (MIAB) for tissue acquisition (TA) from subepithelial lesions (SELs) is emerging as an alternative to endoscopic ultrasound (EUS)-guided TA. Only a limited number of studies compared the diagnostic utility of MIAB and EUS for upper gastrointestinal (GI) SELs; therefore, we conducted this systematic review and meta-analysis.
Methods
A comprehensive literature search from January 2020 to January 2022 was performed to compare the diagnostic accuracy and safety of MIAB and EUS-guided TA for upper GI SELs.
Results
Seven studies were included in this meta-analysis. The pooled technical success rate (risk ratio [RR], 0.96; 95% confidence interval [CI], 0.89–1.04) and procedural time (mean difference=–4.53 seconds; 95% CI, –22.38 to 13.31] were comparable between both the groups. The overall chance of obtaining a positive diagnostic yield was lower with EUS than with MIAB for all lesions (RR, 0.83; 95% CI, 0.71–0.98) but comparable when using a fine-needle biopsy needle (RR, 0.93; 95% CI, 0.83–1.04). The positive diagnostic yield of MIAB was higher for lesions <20 mm (RR, 0.75; 95% CI, 0.63–0.89). Six studies reported no adverse events.
Conclusions
MIAB can be considered an effective alternative to EUS-guided TA for upper GI SELs without an increased risk of adverse events.

Keyword

Biopsy; Endoscopic ultrasound; Mucosal incision; Subepithelial lesion

Figure

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  Fig. 1. Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) flowchart for the study selection process.

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  Fig. 2. Risk of bias assessment for randomized controlled trials (A) and non-randomized studies (B).

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  Fig. 3. Forest plot comparing the technical success between mucosal incision-assisted biopsy and EUS-guided tissue acquisition. EUS, endoscopic ultrasound; MIAB, mucosal incision-assisted biopsy; SD, standard deviation; IV, intravenous; CI, confidence interval.

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  Fig. 4. Forest plot comparing the diagnostic yield between mucosal incision-assisted biopsy and EUS-guided tissue acquisition. EUS, endoscopic ultrasound; MIAB, mucosal incision-assisted biopsy; M-H, Mantel-Haenszel; CI, confidence interval.

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  Fig. 5. Forest plot comparing the diagnostic yield between mucosal incision-assisted biopsy and EUS-guided tissue acquisition for subgroups. (A) Use of EUS-FNB. (B) Size of lesion <20 mm. (C) Gastric subepithelial lesions. EUS, endoscopic ultrasound; FNB, fine-needle biopsy; MIAB, mucosal incision-assisted biopsy; M-H, Mantel-Haenszel; CI, confidence interval.

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  Fig. 6. Forest plot comparing the procedural time between mucosal incision-assisted biopsy and EUS-guided tissue acquisition. EUS, endoscopic ultrasound; MIAB, mucosal incision-assisted biopsy; M-H, Mantel-Haenszel; CI, confidence interval.

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