The Benign Liver EUS Optimal Core Study (BLOCs): A Prospective Randomized Multicenter Study Evaluating Wet-suction...

The specimen quality of endoscopic ultrasound-guided liver biopsy (EUS-LB) for benign liver disease evaluation depends on the technique and type of needle used. Using a 19-gauge (19 g) fine needle biopsy (FNB) needle with 3 actuations and wet suction (WS) or slow stylet pull is the current preferred practice. We conducted a randomized prospective multicenter trial to compare wet suction (WS) to slow stylet pull (SP) technique to compare histologic yields, length of procedure, and adverse events (AE).

This prospective randomized trial (NCT03245580) included patients undergoing EUS-LB for parenchymal biopsy at 6 centers in the United States in 2020-2021. A 19 g Franseen tip EUS needle was used for all procedures. For WS, the needle was flushed with saline, and a 20 ml suction syringe with 3 to 5 ml of fluid was used. For SP, a slow pullback of stylet was used. Pathologist was blinded for tissue interpretation.

One hundred fifty-three patients across 6 tertiary centers were included, with 75 patients in the WS arm and 78 patients in the SP arm. Histologic outcomes were superior in WS compared with SP [aggregate specimen length (46.5 vs. 34.5 mm, P<0.001), length of longest fragment (14 vs. 11 mm, P<0.001), and number of complete portal tracts (16 vs. 11.5, P<0.001)]. The overall ability to make a histological diagnosis was higher in WS (99% vs. 92%). Procedure length and AE did not differ between groups.

The use of WS compared with SP for EUS-LB resulted in superior specimen yields. Total procedure time and adverse events were similar for both techniques.