Su1299 COMPARISON OF THE PERFORMANCE OF 2 CORE BIOPSY NEEDLES FOR ENDOSCOPIC ULTRASOUND-GUIDED LIVER BIOPSY

Abstract

Endoscopic ultrasound-guided fine needle biopsy of the liver (EUS-LB) is a safe and effective technique to assess liver histology. EUS-LB is commonly performed using a 19-gauge fine needle biopsy (FNB). Two popular models used for EUS-LB differ in tip geometry. One has a 3-planed, Franseen-style tip with symmetric cutting surfaces (Acquire; Boston Scientific; Marlborough, MA). The other has a 2-pronged, fork-tip with asymmetric cutting surfaces (SharkCore; Medtronic; Sunnyvale, CA). Herein, we compare these two needles with respect to safety and tissue yield in EUS-LB. This is a retrospective analysis of all patients referred for EUS-LB between January 2017 and May 2019. All EUS-LB were performed using 19G Franseen or fork-tip needles, but the specific model selection, biopsy location, and number of passes were at endoscopist’s discretion. EUS-LB was performed via one pass, one actuation, wet suction technique without on-site cytopathology. All endoscopists grossly evaluated the specimen procured from each pass to determine whether another pass was needed. One hundred sixteen patients underwent EUS-LB. Franseen and fork-tip needles were employed in 71 and 89 cases respectively. Baseline patient characteristics were similar between the cohorts. Overall, both needles yielded comparable results with respect to aggregate length (29.5 vs 27mm, p=0.39), longest intact core (16.7 vs 19.8mm, p=0.10) and complete portal tracts (18.1 vs 16.9, p=0.47). However, more passes were performed with fork-tip (146) compared to Franseen needles (100), with a mean of 1.64 vs 1.41 (p=0.02). When only single pass biopsies were examined (46 Franseen, 39 fork-tip), the Franseen needle yielded statistically greater aggregate length (34.4 vs 27.1mm, p=0.05) and longest intact core (23.1 vs 17.5mm, p=0.01). Four EUS-LB procedures (2.5%) resulted in samples that were inadequate for histologic diagnosis (Franseen-1.4%, fork-tip-3.4%; p=NS). Adverse events after EUS-LB consisted of two cases of post-procedural bleeding (1.3%) not requiring intervention; one after Franseen (1.4%) and one after fork-tip FNB (1.1%; p=NS). Both Franseen and fork-tip fine needle biopsy needles appear safe and effective for endoscopic ultrasound-guided liver biopsy. However, fewer passes are needed and more tissue is procured in a single pass when using the Franseen model.Figure 1Comparison of results of endoscopic ultrasound-guided liver biopsy using the Franseen and Fork-tip needle systems between all samples (above) and single-pass only samples (below). Metrics examined were aggregate length (mm), longest intact core (mm) and complete portal tracts.View Large Image Figure ViewerDownload Hi-res image Download (PPT)