A Multi-Center Retrospective Study of 420 EUS-Guided Fine Needle Core Liver Biopsy with a Modified 1-Pass 1-Actuation Wet Suction Technique Comparing Two Types of EUS Core Needles

Abstract

Introduction: Endoscopic Ultrasound guided (EUS) Fine Needle Core Biopsy (FNCB) has proven to be safe and effective technique for diagnosis and staging of liver parenchymal disease. We evaluated the diagnostic yield, specimen adequacy in EUS-guided parenchymal biopsies and documented adverse events. We compared two types of EUS 19 G core needles. Methods: This is a multi-center, retrospective study of 420 patients with unexplained abnormal liver function tests who were referred for EUS evaluation of elevated liver enzymes to evaluate for biliary obstruction and pancreatic pathology. EUS-guided liver biopsy (EUS-LB) was performed at the same session after biliary obstruction was excluded. We compared EUS-LB in 210 patients using a Franseen needle to 210 patients using a Fork-tip needle, using a modified 1-pass 1-actuation wet suction technique in patients referred for abnormal liver function tests. We compared intact specimen length (ISL), total specimen length (TSL), complete portal triads (CPT) and adverse events (AE). Comparison between means used a 2-sample Z test and Levene's test found equal variance between all compared means except for mean TSL of patients with a fibrosis score of 0-2. Results: 420 consecutive patients underwent EUS-LB and data were retrospectively evaluated. Median patient age was 52 yrs(range 7-84) and 185(44%) were male. The fork tip needle had an average ISL of 2.7 cm, TSL of 6 cm, and mean 19.5 CPT(range 7-73). Abdominal pain occurred in 35 patients(17%) immediately post-procedure, which resolved in all patients except two after intravenous administration of a low-dose narcotic. Subcapsular hematomas occurred in 1(0.5%) patients. The Franseen needle had an average ISL of 3.1 cm, TSL of 6.5 cm, and mean of 24 CPT(range 8-49). Abdominal pain occurred in 4 patients(2%) immediately post-procedure, which resolved in all patients after intravenous administration of a low-dose narcotic. Subcapsular hematoma occurred in 1(0.5%) and bile leak in 1(0.4%) patients. Conclusion: This is a multi-center comparative study of 2 19G second generation EUS needles of different designs, in patient undergoing EUS-LB. The average CPT and ISL were significantly higher in the Franseen needle compared to fork-tip needle. Both needles using a modified 1-pass 1-actuation wet suction technique met 100% AASLD specimen adequacy (>11 CPT or TSL >2.5cm). AE were comparable between both needles.752_A Figure 1. Gross Specimen752_B Figure 2. Comparison between needle type based on fibrosis score752_C Figure 3. Comparison between Franseen and Fork-tip needles