Endoscopic ultrasound-guided liver biopsy using a 22-G fine needle biopsy needle: a prospective study

Abstract

Background Endoscopic ultrasound-guided liver biopsy (EUS-LB) using a 19-gauge (19-G) EUS needle is becoming increasingly popular. We evaluated the efficacy and safety of a 22-G EUS fine needle biopsy (FNB) needle for performing EUS-LB. Methods Patients referred for evaluation of elevated liver enzymes and without obstructive disease requiring endoscopic retrograde cholangiopancreatography (ERCP) were included. Using a 22-G FNB needle, two passes were made from the left lobe and one from the right. The main outcome measure was adequacy of the specimen for histology interpretation, and the secondary outcome was the safety of EUS-guided liver biopsy with a 22-G FNB needle. Patients were followed for post-procedure complications for 30 days. Results 40 patients (median age 61 years; 26 women) underwent EUS-LB. Analyzing by needle passes, the median longest core fragment was 12 mm (1st quartile – 3rd quartile 10 mm – 16.25 mm, interquartile range [IQR] 6.25 mm) from the left lobe and 11 mm (10 mm – 15.75 mm, IQR 5.75 mm) from the right lobe. The median cumulative core length per patient was 55 mm (44.5 mm – 68 mm, IQR 23.5 mm). The median cumulative number of complete portal triads (CPTs) per patient was 42 (28.5 – 53, IQR 24.5). The specimen was considered adequate in all 40 patients (100 %). Self-limiting abdominal pain was reported in 6 patients (15 %). Conclusions EUS-LB using a 22-G FNB needle is a safe and viable alternative to the use of larger gauge needles, yielding adequate tissue for evaluation of parenchymal disease in 100 % of the patients.

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

“…In a recent study by Hasan MK et al, efficacy and safety of 22-G EUS-FNB for performing EUS-MLB was evaluated. Forty patients were included in the study and in 100 % of them, a 22-G needle was able to provide sufficient unfragmented core tissue with 100 % histological diagnosis of parenchymal liver disease [21]. Our current study with 420 patients is the first head-to-head study of its size to compare different two kinds of core needles for obtaining tissue in evaluation of parenchymal liver disease.…”

Superior Specimen and Diagnostic Accuracy with Endoscopic Ultrasound-Guided Liver Biopsies Using 19-Gauge versus 22-Gauge Core Needles

“…Multiple studies have reported adequate EUS-LB specimens with various needle types and gauges, including 19 G and 22 G, but required a significant number of needle actuations in the liver, ranging from 9-20. [6][7][8][9]13 One study showing very high specimen adequacy with only two total needle actuations was the single-pass, single-actuation, wet suction technique by Nieto et al 9 This study used a 19 G needle to obtain a specimen from the left and right lobes. Our study aimed to determine whether reducing the number of needle passes to a single actuation in the left lobe with various needle gauges, including both 19 G and 22 G, would still be adequate.…”

“…Multiple studies have shown success with both 19 and 22 G needles; however, the number of needle actuations into the liver parenchyma was high, ranging from 9 to 20. [6][7][8] Theoretically, the risk of complications increases with the number of needle actuations. Thus, limiting this number while still procuring an adequate specimen is ideal.…”

Safety and adequacy of endoscopic ultrasound-guided random liver biopsy in comparison with transjugular and percutaneous approaches

“…▶ quacy and efficacy [21][22][23]. EUS-LB confers an advantage over other modalities of being able to obtain tissue from multiple segments of the liver, thus limiting sample error [24].…”