Practice patterns of endoscopic ultrasound-guided tissue acquisition of solid pancreatic masses: an international survey study

Background Advancements in endoscopic ultrasound-guided tissue acquisition (EUS-TA) for solid pancreatic masses have prompted updates in society guideline recommendations. However, the extent to which these recommendations have been adopted in clinical practice remains unclear. Thus, we sought to characterize current practice patterns and beliefs regarding EUS-TA for solid pancreatic masses in a large, international cohort of endosonographers. Methods We developed and distributed an electronic survey to 1,281 endosonographers worldwide between September and November 2024. The survey aimed to evaluate EUS-TA practices across six domains: A) needle selection, B) sampling technique, C) method guiding the number of passes, D) specimen handling, E) quality indicator (QI) monitoring, and F) factors influencing decision-making. Results The response rate was 30% ( n = 376). Most endosonographers often or always use fine needle biopsy (FNB) needles (90%) of 22-gauge (85%) and Franseen design (53%). The majority use a fanning technique (79%) and perform ≤ 10 actuations (60%). The number of FNB passes is mostly guided by visual on-site evaluation (60%). Advanced EUS imaging utilization was low (EUS elastography: 14%; contrast-enhanced EUS: 8%). Institutional QI monitoring was reported by 51% of endosonographers. Compared to other regions, endosonographers in North America are more likely to use rapid on-site evaluation, but less likely to use advanced EUS imaging modalities or have QI monitoring (all p < 0.001). Conclusion There are significant global variations in EUS-TA practices for solid pancreatic masses. These survey data provide a benchmark to guide standardization, inform quality monitoring, and support evolving technologies to optimize diagnostic outcomes and patient care worldwide.