Single-incision needle-knife biopsy for the diagnosis of GI subepithelial tumors: a systematic review and meta-analysis

Background and Aims: A histologic diagnosis of GI subepithelial tumors (SETs) is important because of the malignant potential of these lesions. The current modalities of choice, including EUS-guided FNA and biopsy (EUS-FNA/FNB) have demonstrated suboptimal diagnostic success. Single-incision with needle-knife (SINK) biopsy has emerged as an alternative diagnostic approach to increase tissue acquisition and diagnostic success. The aim of this study was to perform a systematic review and meta-analysis to evaluate the technical success, diag-nostic success, and adverse events of SINK biopsy. Methods: We searched multiple databases including PubMed, EMBASE, CINAHL, Cochrane, Web of Science, and Google Scholar from inception to July 2022. The primary outcomes assessed were the technical success and diag-nostic success of SINK in GI SETs. The secondary outcomes assessed were adverse events and whether immuno-histochemical analysis could be successfully performed on tissue samples obtained via SINK. Results: Seven studies with a total of 219 SINK biopsy procedures were included in this meta-analysis. The tech-nical success rate was 98.1% (95% CI, 94.9%-99.3%; P = .000; I-2 = .0%), and the diagnostic success rate was 87.9% (95% CI, 82.6%-91.7%; P = .000; I-2 = .0%). The immunohistochemical success rate was 88.3% (95% CI, 78.7%-93.9%; P = .000; I-2 = 3.5%). The rate of adverse events was 7.5% (95% CI, 4.3%-12.7%; P = .00; I-2 = 7.2%), and bleeding was the most common adverse event. Conclusion: SINK biopsy is a safe diagnostic procedure with a high technical and diagnostic success in patients with GI SET. Further randomized controlled trials and direct comparison studies are needed to validate these find-ings. (Gastrointest Endosc 2023;97:640-5.)

Automated summary

This study evaluated the technical success, diagnostic success, and adverse events of single-incision with needle-knife (SINK) biopsy in gastrointestinal subepithelial tumors (SETs) through a systematic review and meta-analysis. The results showed that SINK biopsy had a high level of technical and diagnostic success, but further research is needed to validate these findings.