EUS-guided fine-needle core liver biopsy with a modified one-pass, one-actuation wet suction technique comparing two types of EUS core needles

Jose Nieto, Enad Dawod, Ameya Deshmukh, Eli Penn, Douglas Adler, Sammy Saab, Jose Nieto, Enad Dawod, Ameya Deshmukh, Eli Penn, Douglas Adler, Sammy Saab

Abstract

Background and study aims We compared the diagnostic yield and specimen adequacy in EUS-guided parenchymal biopsies between two types of EUS 19 G core needles. Patients and methods This is a retrospective study of 420 patients at two tertiary medical centers in Florida with unexplained abnormal liver associated tests were referred for EUS evaluation of biliary obstruction and pancreatic pathology. EUS-guided liver biopsy (EUS-LB) was performed at the same session after biliary obstruction was excluded. We compared intact specimen length (ISL), total specimen length (TSL), complete portal triads (CPT) and adverse events (AE). Welch's T and Tukey tests were used for ISL, TSL and CPT. Results A total of 210 patients underwent EUS-LB using a Franseen needle, 210 patients using a fork-tip needle. Median patient age was 52 years (15.63) and 238 (56.7 %) were female. The fork-tip needle had a mean ISL of 2.7 (1.1 SD) cm, TSL of 6 cm (2.1 SD), and mean 19.5 CPT (8.5 SD) Abdominal pain occurred in 35 patients (17 %) post-procedure and was managed with supportive care. Two patients required intravenous (IV) narcotic administration. Subcapsular hematomas occurred in 1 (0.5 %) patients. The Franseen needle had a mean ISL of 3.1 cm (1.3 SD), TSL of 6.5 cm (2.6 SD), and mean of 24 CPT (8.8 SD). Abdominal pain occurred in four patients (2 %) post-procedure, which resolved in all patients after IV narcotic administration. Subcapsular hematomas occurred in 1 (0.5 %) and bile leak in 1(0.4 %) patients. Conclusions Use of the Franseen needle resulted in better liver core samples than that obtained with a fork-tip needle.

Conflict of interest statement

Competing interests Dr. Nieto is a consultant for Boston Scientific and Olympus. Dr. Adler is a consultant for Boston Scientific and Olympus.

Figures

Fig. 1
Fig. 1
Live view of parenchymal tissue obtained via EUS.
Fig. 2
Fig. 2
Mean intact specimen length (ISL) and total specimen length (TSL) comparison with inclusion of all patient types.
Fig. 3
Fig. 3
Comparison with inclusion of all patient types between the two needles in terms of complete portal tracts (CPT).

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