Response

Abstract

We thank Dr Confer et al1Confer B.D. Walker J.T. Khurana S. et al.EUS-guided liver biopsy: the type of needle matters.Gastrointest Endosc. 2019; 90: 321-322Google Scholar for their letter in response to our article “Efficacy and safety of EUS-guided liver biopsy: a systematic review and meta-analysis.”2Mohan B.P. Shakhatreh M. Garg R. et al.Efficacy and safety of EUS-guided liver biopsy: a systematic review and meta-analysis.Gastrointest Endosc. 2019; 89: 238-246.e3Google Scholar The primary focus of our study was to demonstrate the clinical performance of EUS-guided liver biopsy (EUS-LB) based on available studies in literature, and to do so we had to include all published studies to this end. The letter by Dr Confer et al1Confer B.D. Walker J.T. Khurana S. et al.EUS-guided liver biopsy: the type of needle matters.Gastrointest Endosc. 2019; 90: 321-322Google Scholar visits a very important clinical question: What is the best needle to use for EUS-LB? Although this was not the primary focus of our study, we did attempt to find an answer to this clinically pertinent question in our subgroup analysis. Based on the included studies in our analysis, we demonstrated that, in general, an FNA needle seemed to give a better liver biopsy outcome than a fine-needle biopsy (FNB) needle. Statistical significance was noted in the rate of insufficient specimens collected between these needles. This was based, in part, on studies that used QuickCore and ProCore needles. As Dr Confer and team rightly pointed out, the QuickCore needle has been deemed inferior for EUS-LB, and our study confirms this finding. Multiple different FNB needles have been made available for commercial use in the past several years. These devices are designed primarily to obtain core tissue samples of solid mass lesions under EUS guidance. The Franseen-tip needle (Acquire; Boston Scientific, Natick, Mass) and the Fork-tip needle (SharkCore; Medtronic Corporation, Newton, Mass, and Covidien, Dublin, Ireland) are designed to get larger tissue samples. The Franseen design has a tip with 3 symmetric cutting edges designed to get deep into the tissue and obtain ample tissue volume because of its large crown-tip area. The Fork-tip needle has a second sharp tip on the opposite side of the lumen, giving it 6 asymmetric cutting surfaces to aid in tissue capture. We, unfortunately, did not have liver biopsy data based on the Franseen-tip needle in EUS-LB. The new FNB needles are promising in the biopsy of solid organs of the GI tract, and this may hold true for EUS-LB as well. We eagerly look for the submitted prospective study by Dr Confer and team comparing the Franseen FNB needle and the standard beveled FNA needle. In our experience, both FNA and FNB needles have provided excellent liver biopsy samples. We hope that additional data regarding the use of FNB needles for EUS-LB will be forthcoming. EUS-guided liver biopsy: the type of needle mattersGastrointestinal EndoscopyVol. 90Issue 2PreviewWe read with interest the meta-analysis of EUS-guided liver biopsy (EUS-LB),1 particularly after members of our hepatology practice (who have fully embraced EUS-guided liver biopsy) asked whether we should switch back from a fine-needle biopsy (FNB) needle to an FNA needle on the basis of this study’s results. Full-Text PDF