***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Abstract Objectives . Endoscopic ultrasonography-guided fine needle aspiration ( EUS-FNA ) is widely performed for pancreatic masses . The 25-gauge needle ( 25 G ) might be easier to be manipulated and expected to be associated with fewer complications since it is thinner and more flexible than the 22-gauge needle ( 22 G ) although obtaining adequate specimens is question ed . In this r and omized trial , the authors tried to compare prospect ively 25 G and 22 G in diagnostic accuracy , manipulability from the operator 's viewpoint and procedure-related complications . Material and methods . A total of 188 consecutive patients undergoing EUS-FNA for solid or cystic pancreatic masses were consecutively enrolled and 94 patients were r and omized to either 25 G or 22 G group , respectively . Results . Baseline characteristics were similar except that more masses of 25 G group were located in the head or uncinate process of pancreas than those from 22 G group . Although there was no difference in diagnostic accuracy ( 89.4 % vs. 88.3 % with p = 0.82 ) , 25 G was easier to be manipulated ( p = 0.004 ) and related with fewer procedure-related complications ( 10.6 % vs. 3.2 % with p = 0.004 ) . Conclusions . 25 G can be chosen in preference to 22 G when performing pancreatic EUS-FNA because 25 G was significantly superior to 22 G in terms of manipulability and complications although both were effective for accurate diagnosis BACKGROUND The role of the forward-viewing echoendoscope compared with the oblique-viewing echoendoscope for EUS-guided FNA ( EUS-FNA ) of upper GI subepithelial lesions has not been defined . OBJECTIVE To compare the diagnostic yield and clinical efficacy of EUS-FNA by using the 2 echoendoscopes in the same upper GI subepithelial lesion . DESIGN Prospect i ve , r and omized , crossover study . SETTING Tertiary-care medical center . PATIENTS Forty-one patients with an upper GI subepithelial lesion . INTERVENTIONS All patients first underwent EUS-FNA with a 19-gauge needle by using both echoendoscopes , based on r and om selection . When required , 22-gauge or 25-gauge needles were used additionally . MAIN OUTCOME MEASUREMENTS Comparison of diagnostic yield , tissue sample area , puncture success rates , procedure time , and adverse events . RESULTS Forty-one patients ( median lesion size 22 mm , range 15 - 63 mm ) were enrolled .  Rates of histologic diagnosis were 80.5 % ( 33/41 ) and 73.2 % ( 30/41 ) ( P=.453 ) by using forward-viewing and oblique-viewing echoendoscopes , respectively . Median tissue sample area in GI stromal tumors ( n=22 ) obtained with the forward-viewing echoendoscope was larger than with the oblique-viewing echoendoscope ( 2.46 mm2 vs 1.00 mm2 ; P=.046 ) . Puncture success rates were 39 of 41 ( 95.1 % ) and 35 of 41 ( 85.4 % ; P=.289 ) with forward-viewing and oblique-viewing echoendoscopes , respectively . Median procedure time was 21 minutes with the forward-viewing echoendoscope and 27 minutes with the oblique-viewing echoendoscope ( P=.009 ) . An infectious adverse event occurred in a patient and was treated with antibiotics . LIMITATIONS Small sample size . CONCLUSION Diagnostic yield did not differ between the 2 echoendoscopes . However , tissue sample area and procedure time were superior with the forward-viewing echoendoscope BACKGROUND A new needle platform for endoscopic ultrasound-guided fine-needle aspiration biopsy has been developed that allows interchangeability of all needle sizes . AIMS To prospect ively compare the efficacy of the new 25-G needles and 22-G needles for obtaining an adequate aspirate of solid masses . METHODS R and omized controlled trial of 144 patients referred for endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses , intraparietal tumours , or lymph-nodes , r and omized to the 25-G or 22-G needle arms . RESULTS An adequate specimen was obtained from 74.3 % of cases . The sample tended to be more adequate in the 25-G compared to the 22-G group ( 81 % vs. 68 % ; p=0.09 ) . Crossover was required in 14 ( 19 % ) and 12 ( 17 % ) cases in the 22-G and in the 25-G groups , respectively ( p=0.7 ) . The overall rate of adequacy improved from 74 % before crossover to 90 % after crossover ( p<0.01 ) . When comparing the two groups after crossover , the rate of obtaining adequate sample s was significantly higher in the 25-G arm than in the 22-G arm ( 95.8 % vs. 86.1 % ; p=0.03 ) . CONCLUSIONS The 25-G needle was superior to the 22-G needle for endoscopic ultrasound-guided fine-needle aspiration biopsy . The adequacy and diagnostic accuracy improved after crossover , reaching 90 % Background and study aims : Two 22 G needles with similar design s , apart from the absence ( A ) or presence of a side port ( B ) , are available for endoscopic ultrasound (EUS)-guided fine-needle aspiration ( FNA ) . The side port was design ed to increase diagnostic yield but this advantage was unproven . This study evaluated the difference in diagnostic yield between both needles in pancreatic masses . Patients and methods : This was a prospect i ve multicenter r and omized cross-over study . Patients with pancreatic masses were r and omized to one needle for the first two passes , followed by the other for the next two passes . A pathologist blinded to the needle assessed each puncture for cellularity and morphology . The diagnostic yield between both needles was compared . Results : In total , 30 patients were recruited ( mean lesion size : 3.5 cm , range : 1.2 – 6.3 ) . Comparison of cellularity adequacy : first pass : A vs. B : 26/30 vs. 24/30 ( P = 0.488 ) : 2nd pass : A vs. B : 25/30 vs. 26/30 ( P = 0.718 ) . Comparison of diagnostic accuracy : first pass : A vs. B : 22/30 vs. 23/30 ( P = 0.766 ) ; after two passes : A vs. B : 26/30 vs. 26/30 ( P = 1.0 ) . When all four passes were assessed , adequate cellularity was obtained in 29/30 and the correct diagnosis was obtained in 28/30 patients . There were no procedural complications . Conclusions : There was no significant difference in diagnostic yield between EUSFNA needles with or without a side port for pancreatic masses . Study registration : NCT02092519 Objectives Although a large gauge needle can procure more tissue at endoscopic ultrasound-guided fine needle aspiration ( EUS-FNA ) , its advantage over smaller needles is unclear . This study compared flexible 19 G and 25 G needles for EUS-FNA of solid pancreatic masses . Methods This was a r and omized trial of patients undergoing EUS-FNA of pancreatic masses using flexible 19 G or 25 G needle .  Main outcome measure was to compare median number of passes for on-site diagnosis . Secondary measures were to compare specimen bloodiness , complications , technical failures , and histological core tissue procurement . Results One hundred patients were r and omized to EUS-FNA using flexible 19 G or 25 G needle .  Median of 1 pass was required to achieve on-site diagnosis of 96 % and 92 % ( P = 0.68 ) in 19 G and 25 G cohorts . There was no significant difference in technical failure ( 0 % vs 2 % , P = 0.99 ) or adverse events ( 2 % vs 0 % , P = 0.99 ) between 19 G and 25 G cohorts . Although histological core tissue procurement was significantly better with flexible 19 G needle ( 88 % vs 44 % , P < 0.001 ) , specimens were bloodier ( severe bloodiness , 36 % vs 4 % ; P < 0.001 ) . Conclusions As there is no significant difference in the performance of flexible 19 G and 25 G needles , needle choice for sampling pancreatic masses should be based on endoscopist preference and need for histology BACKGROUND The difference in the diagnostic accuracy of 22- versus 25-gauge needles in EUS-FNA is not clear . AIMS To compare the rates of technical success , diagnostic accuracy and complications of EUS-FNA performed with 22-gauge and 25-gauge needles on the same solid pancreatic mass . METHODS All patients with solid pancreatic masses evaluated from September 2007 to December 2008 were enrolled and underwent  EUS-FNA with both 22- and 25-gauge needles with r and omisation of needle sequence . The accuracy of the EUS-FNA was determined by comparing the cytological results with the final surgical pathological diagnoses or with the results of a clinical follow-up . A cytological score with different qualitative parameters was created , and a comparison between these parameters was carried out for each needle . RESULTS Fifty patients with 50 pancreatic masses were recruited .  Technical success was 100 % and no complications occurred . Diagnostic accuracy was 94 % and 86 % for the 25- and 22-gauge needles , respectively . Analysis of the cytological score showed a tendency towards the 25-gauge needle , although the difference was not statistically significant . CONCLUSIONS EUS-FNA performed with 22- or 25-gauge needles had the same diagnostic accuracy . Our study results confirm a significant trend towards a better cytological diagnosis for the 25-gauge needle Context Clinicians often use multidetector computed tomography or endoscopic ultrasonography to detect and stage pancreatic cancer . Contribution This prospect i ve study found that , among 80 adults with proven pancreatic cancer , the sensitivity of multidetector computed tomography and endoscopic ultrasonography for detecting a pancreatic mass was 86 % ( CI , 77 % to 93 % ) and 98 % ( CI , 91 % to 100 % ) , respectively . Among 53 patients undergoing surgery , endoscopic ultrasonography was more accurate for staging local tumor spread , but both tests showed similar accuracy for nodal staging and detecting resectability . Caution s Optimal strategies to detect and stage pancreatic cancer may vary across sites depending on the expertise of radiologists and endosonographers . The Editors In the United States for the year 2003 , it was estimated that pancreatic cancer would be diagnosed in approximately 30700 patients and contribute to 30000 deaths ( 1 ) . Complete surgical removal with negative histologic margins ( R0 resection ) is an independent predictor of postoperative survival ( 2 - 4 ) and remains the only potential curative treatment for pancreatic cancer . At surgical exploration , however , only 5 % to 25 % of the tumors are amenable to resection ( 5 - 8 ) . Therefore , the principle goal of preoperative evaluation is to identify patients with potentially resectable disease while avoiding surgical exploration in those with unresectable disease . There is no evidence -based consensus on the optimal preoperative imaging assessment of patients with suspected pancreatic cancer . Because of widespread availability , helical computed tomography ( CT ) is usually the initial study for this indication ( 9 , 10 ) . Dual-phase helical CT , during which postinjection contrast image acquisition is obtained in both the pancreatic ( arterial ) and portal venous phases , has improved detection rate and assessment of resectability in patients with suspected pancreatic cancer ( 11 , 12 ) . Current state-of-the-art CT imaging uses a multiple-row detector with narrow detector collimation , wide x-ray beam , and rapid table translation ; these features offer faster acquisition and thinner image slices compared with single-detector CT ( 13 - 15 ) . Whether multidetector CT offers improved detection and staging of pancreatic cancer , however , is unknown . Endoscopic ultrasonography has been shown to be superior to conventional CT for the detection ( 16 - 20 ) and staging ( 19 , 20 ) of pancreatic cancer . When compared with helical CT , however , endoscopic ultrasonography is reported to be either equivalent for detection ( 21 , 22 ) or superior for detection or staging ( 23 - 25 ) . To date , no comparative studies of multidetector CT with other imaging tests , including endoscopic ultrasonography , for suspected pancreatic cancer have been performed . Therefore , we conducted a prospect i ve trial to compare endoscopic ultrasonography and multidetector CT for the detection , staging , and resectability of suspected locoregional pancreatic cancer 
    Output:
    
Based on r and omized studies , this meta- analysis did not demonstrate a significant difference between the 22 G and 25 G needles used during EUS-FNA in the diagnosis of solid pancreatic lesions