Approach to management of bleeding during EUS-guided liver biopsy: salvage therapy using absorbable gelatin sponge

EUS-guided liver biopsy (EUS-LB) has emerged as a reliable alternative to interventional radiology-guided biopsy, offering comparable specimen adequacy. Bleeding remains the most common adverse event. We describe a novel use of absorbable gelatin sponge slurry for hemostasis during EUS-LB and propose a stepwise management approach.

Liver biopsy was performed using a dynamic suction technique with a 19-gauge fine-needle biopsy needle. After biopsy, e-Flow Doppler was used to evaluate for bleeding. Since Doppler flow persisted, initial management included leaving the needle in place for 4 minutes and performing a blood patch technique. For bleeding extending beyond the liver capsule, a gelatin sponge slurry was prepared by macerating absorbable gelatin pledgets into a thick gel using the Tessari technique. The slurry was injected into the bleeding tract while withdrawing the needle under EUS guidance.

Application of this stepwise approach during EUS-LB successfully achieved hemostasis without the need for surgical or radiologic intervention. The gelatin sponge slurry effectively sealed the bleeding tract, with no significant postprocedural hematoma or ongoing hemorrhage observed.

The use of an absorbable gelatin sponge slurry represents a promising salvage technique for managing bleeding during EUS-LB when conventional methods fail.