Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is useful in diagnosing subepithelial lesions (SELs), and adequate tissue sampling is necessary to differentiate between benign and malignant diseases to determine therapeutic strategies. This study aimed to evaluate sampling adequacy and diagnostic performance of EUS-FNA for SELs with Franseen needles. This retrospective study enrolled 130 patients who underwent EUS-FNA with a 22-gauge needle for SELs from January 2010 to March 2021. We compared sampling adequacy and predictive factors influencing the sampling adequacy of EUS-FNA for SELs between Franseen and conventional needles. The sampling adequacy rates were 95.0% (38/40) with Franseen needles and 76.7% (69/90) with conventional needles (p = 0.011). The mean number of punctures with Franseen needles (2.80) was significantly less than that with conventional needles (3.42) (p < 0.001). In the multivariate analysis, the use of Franseen needles (p = 0.029; odds ratio [OR], 5.37; 95% confidence interval [CI], 1.18–23.36) was an independent factor influencing the sampling adequacy. Compared to conventional needles, the Franseen needle could play a vital role in accurately diagnosing SELs by yielding better sampling adequacy and reducing the number of passes.

Objectives: Endoscopic papillectomy (EP) is a minimally invasive treatment for ampullary tumors; however, its safety in elderly patients remains unclear. We aimed to evaluate the feasibility and clinical outcomes of EP in this population. Methods: This multicenter retrospective study included 255 patients with ampullary tumors who underwent EP between April 2008 and September 2025 at three collaborating institutions. Patients aged ≥ 75 years were defined as elderly; complication rates and clinical outcomes were compared with the non‐elderly group. Results: The elderly group had a significantly higher Charlson Comorbidity Index (1.0 [0–8] vs. 0 [0–7]; p = 0.028). The elderly group demonstrated significantly lower rates of overall complications (29.0% vs. 48.9%; p = 0.004), delayed bleeding (4.3% vs. 23.1%; p < 0.001), and pancreatitis (11.6% vs. 23.1%; p = 0.041) than the non‐elderly group. Serious complications rate (4.3% vs. 4.8%; p = 1.000), median hospital stay (12 [7–73] vs. 13 [4–40] days; p = 0.408) were comparable between groups. Multivariate analysis showed that age ≥ 75 years was independently associated with a reduced risk of delayed bleeding ( p = 0.002; odds ratio [OR], 0.14) and pancreatitis ( p = 0.029; OR, 0.39). Conclusions: EP in patients aged ≥ 75 years was associated with lower complication rates and may be a feasible treatment option.