Background and study aims: It is uncertain if needle gauge impacts the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of pancreatic mass lesions. Our aim was to use meta-analysis to more robustly define the diagnostic accuracy of EUS-FNA for pancreatic masses using 22 G and 25 G needles. Patients and methods: Studies were identified by searching nine medical databases for reports published between 1994 and 2011, using a reproducible search strategy comprised of relevant terms. Only studies comparing the overall diagnostic accuracy of 22 G vs. 25 G EUS needles that used surgical histology or at least 6 months clinical follow up for a gold standard were included. Two reviewers independently scored the identified studies for methodology and abstracted pertinent data. When required, the original investigators were contacted to provide additional data. Pooling was conducted by both fixed-effects and random-effects models. Diagnostic characteristics (sensitivity, specificity, positive and negative likelihood ratios) with 95 % confidence intervals (CIs) were calculated. Results: Eight studies involving 1292 subjects met the defined inclusion criteria. Of the 1292 patients, 799 were in the 22 G group and 565 were in the 25 G group (both needles were used in 72 patients). The pooled sensitivity and specificity of the 22 G needle were 0.85 (95 %CI 0.82 – 0.88) and 1 (95 %CI 0.98 – 1) respectively. The pooled sensitivity and specificity of the 25 G needle were 0.93 (95 %CI 0.91 – 0.96) and 0.97 (95 %CI 0.93 – 0.99) respectively. The bivariate generalized linear random-effect model indicated that the 25 G needle is associated with a higher sensitivity (P = 0.0003) but comparable specificity (P = 0.97) to the 22 G needle. Conclusions: This meta-analysis suggests 25 G needle systems are more sensitive than 22 G needles for diagnosing pancreatic malignancy.

Pancreatic cancer is the fourth leading cause of cancer death with a 5-year survival rate of approximately 10%.¹ Noncomparative data from 2013 showed increasing incidence of pancreatic cancer in older White women and men and in younger non-Hispanic White women.² However, there are limited data on recent trends in pancreatic cancer incidence.

Objective Cap-assisted colonoscopy (CAC) uses a small plastic transparent cap attached to the tip of the colonoscope that can depress and flatten colonic folds and thus improve visualisation of their proximal aspects. The aim of this study was to compare CAC with standard colonoscopy (SC; high-definition white light) for adenoma detection rates. Design This is a prospective randomised controlled trial. Setting The study was performed in a tertiary-care Veterans Affairs Medical Center in the USA. Patients Subjects undergoing screening or surveillance colonoscopy were enrolled. Interventions Subjects were randomised to undergo either CAC or SC. Main outcome measures The outcome measures were the proportion of subjects with at least one adenoma, the number of adenomas detected per subject, insertion time, caecal intubation rates and complications. Results 420 subjects were enrolled and included in the study (210 in each group). The proportion of subjects with at least one adenoma was higher with CAC compared to SC (69% vs 56%, p=0.009). CAC also detected a higher number of adenomas per subject (2.3 vs 1.4, p<0.001). The caecal intubation time was shorter with CAC (3.29 min vs 3.98 min, p<0.001). The caecal intubation rates were similar in the two groups (99% vs 98%, p=0.37). There were no complications associated with CAC or SC. Conclusions CAC detected a 13% higher number of subjects with at least one adenoma and 59% higher adenomas per subject. CAC is a safe, effective and practical means to improve adenoma detection rates. Clinical Trial Registration NCT 01211132.