Value of EUS through-the-needle microforceps biopsy sampling in pancreatic cystic lesions: The MOBIDYC trial—A prospective multicenter study (with video)

Background and Objectives: Accurate diagnosis of pancreatic cystic lesions (PCLs) is essential, as some have malignant potential while others are benign. EUS through-the-needle biopsy (EUS-TTNB) using Moray microforceps has emerged as a promising technique for obtaining cyst wall histology, though prospective multicenter data are lacking. Methods: We conducted a nationwide, prospective, multicenter study including 93 patients with PCLs ≥20 mm requiring histological diagnosis after initial imaging work-up. The primary outcome was the histological performance of EUS-TTNB. Secondary outcomes included technical success, predictors of histological performance, safety, and concordance with the gold standard. Results: EUS-TTNB provided adequate histological specimens in 72% of cases, with a 100% technical success rate. Predictive factors for histological performance included proximal location of the PCL ( P = 0.027), absence of tissue component ( P = 0.044), and no main pancreatic duct dilation ( P = 0.025). Adverse events occurred in 17.2% of cases, 12 classified as AGREE I (limited and contained intracystic bleeding n = 10, pain n = 2), 3 AGREE II (bacteremia n = 1, mild acute pancreatitis n = 2), and 1 fatal AGREE V (hemoperitoneum and death of the patient). The concordance with the gold standard for EUS-TTNB (94.7%) was significantly higher than EUS morphology ( P = 0.001) and intracystic CEA ( P = 0.001). Twenty-five patients finally underwent surgery, and histological concordance with surgical specimens was 92%. Conclusion: EUS-TTNB is a valuable tool for diagnosing indeterminate PCLs, with superior performance compared with standard techniques. However, given the risk of adverse events, its use should be reserved for selected cases, especially in high-risk surgical patients.