Adequacy, safety, and technical determinants of a modified EUS-guided liver biopsy sampling technique in patients...

Technique-related factors of EUS-guided liver biopsy sampling (EUS-LB) as a determinant of specimen yield have not been studied. We used a modified technique to study adequacy, safety, and technical determinants in patients with or without cirrhosis.

EUS-LB was performed with a 19-gauge Franseen-tip needle by wet heparinized suction. One or 2 passes with a variable number of actuations were taken, with an endpoint of the aspiration of blood. Primary outcomes were tissue core adequacy and definitive histologic diagnosis. Secondary outcomes were a correlation between the number and depth of actuations with total specimen length (TSL), longest specimen length (LSL), and adverse events (AEs). Early and late AEs were also accessed.

Adequate samples were seen in 48 of 50 patients, and a histologic diagnosis could be achieved in 49 of 50 patients. Mean TSL, LSL, and depth of actuation were 7.98 ± 3.74 cm, 1.89 ± .80 cm, and 4.29 ± .98 cm, respectively. The median number of complete portal tracts was 23 (range, 7-50) and number of actuations was 7 (range, 4-12). The correlation between TSL with number and depth of actuation was r = .71 versus r = .53 and r = .55 versus r = .51 and for LSL was r = .28 versus r = .11 and r = .74 versus r = .55 in noncirrhotic and cirrhotic patients, respectively. No major and 7 (14%) minor AEs were observed.

This modified EUS-LB technique resulted in adequate tissue acquisition and is safe in noncirrhotic and cirrhotic patients. Technical factors like the number and depth of actuations determine specimen yield.