Current status of newer generation endoscopic ultrasound core needles in the diagnostic evaluation of gastrointestinal lesions

Endoscopic ultrasound-guided tissue acquisition is now an imperative technique for the diagnosis of multiple diseases in the gastrointestinal tract and nearby structures. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and fine needle biopsy via dedicated FNB needles (EUS-FNB) are two standard-essential tools for tissue acquisition. The choice of needle type is an important factor determining appropriate tissue acquisition. Multiple studies have compared EUS-FNA versus EUS-FNB on different lesions also there are several studies evaluated different needles in terms of sampling adequacy and cytological and histological accuracy. Prior studies comparing prior-generation FNB needles to FNA did not show an increased diagnostic yield with FNB. However, the newer-generation needles have demonstrated enhanced performance compared with their predecessors. As they may provide a large amount of tissue for the cytological and histological evaluation, rapid onsite specimen evaluation (ROSE), and immunohistochemical and molecular analyses, which may be very important for targeted therapy. In this review, we discuss current evidence and literature on the use of the newer generation needles for pancreatic and non-pancreatic lesions. •Endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) is the diagnostic test of choice for many lesions in the gastrointestinal tract.•EUS-guided FNA has limitations in diagnostic yield in fibrotic pancreatic lesions, lymph nodes, and subepithelial tumors.•Recently, newer generation fine-needle biopsy (FNB) needles have been developed that have demonstrated superior diagnostic yield to standard FNA.•These newer FNB needles also have substantially improved yield in diagnosis of malignant lymph nodes, subepithelial lesions, and fibrotic tumors.•FNB needles have also demonstrated enhanced diagnostic yield in benign lesions such as autoimmune pancreatitis.•Early studies reveal EUS-FNB may also provide histologically adequate liver biopsy samples.