Total Length Of Specimens Research Articles

Adequacy, safety, and technical determinants of a modified EUS-guided liver biopsy sampling technique in patients with or without cirrhosis: a pilot study

Background and AimsEndoscopic ultrasound-guided liver biopsy (EUS-LB) technique-related factors 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. MethodsEUS-LB was performed with a 19G Franseen tip needle by wet heparinized suction. One or two passes with a variable number of actuations were taken, the end-point being 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 (AE). Early and late adverse events (AE) were also accessed. ResultsAdequate samples were seen in 48/50 and histologic diagnosis could be achieved in 49/50 patients. Mean TSL, LSL and depth of actuation were 7.98±3.74cm, 1.89±0.80cm and 4.29±0.98cm, respectively. The median complete portal tracts(CPT) were 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=0.71 vs 0.53 & r=0.55 vs 0.51 and for LSL were r=0.28 vs 0.11 & r=0.74 vs 0.55 in non-cirrhotic and cirrhotic patients respectively. No major and 7(14%) minor adverse events were observed. ConclusionsThis modified EUS-LB technique results in adequate tissue acquisition and is safe in non-cirrhotic and cirrhotic patients. Technical factors like the number and depth of actuations determine specimen yield.

Diagnostic Yield of Endoscopic Ultrasound-Guided Liver Biopsy in Comparison to Percutaneous Liver Biopsy: A Meta-Analysis of Randomized Controlled Trials and Trial Sequential Analysis.

The efficacy of endoscopic ultrasound-guided liver biopsy (EUS-LB) compared to percutaneous liver biopsy (PC-LB) remains uncertain. Our data consist of randomized controlled trials (RCTs) comparing EUS-LB to PC-LB, found through a literature search via PubMed/Medline and Embase. The primary outcome was sample adequacy, whereas secondary outcomes were longest and total lengths of tissue specimens, diagnostic accuracy, and number of complete portal tracts (CPTs). Sample adequacy did not significantly differ between EUS-LB and PC-LB (risk ratio [RR] 1.18; 95% confidence interval [CI] 0.58-2.38; p = 0.65), with very low evidence quality and inadequate sample size as per trial sequential analysis (TSA). The two techniques were equivalent with respect to diagnostic accuracy (RR: 1; CI: 0.95-1.05; p = 0.88), mean number of complete portal tracts (mean difference: 2.29, -4.08 to 8.66; p = 0.48), and total specimen length (mean difference: -0.51, -20.92 to 19.9; p = 0.96). The mean maximum specimen length was significantly longer in the PC-LB group (mean difference: -3.11, -5.51 to -0.71; p = 0.01), and TSA showed that the required information size was reached. EUS-LB and PC-LB are comparable in terms of diagnostic performance although PC-LB provides longer non-fragmented specimens.

Reproductive Traits of an Endangered Loach, Triplophysa kashmirensis (Hora, 1922) in Kashmir Himalaya, India

In this study, a total of 180 specimens of Triplophysa kashmirensis were studied. The total length of specimens varied from 54.85 mm to 130.17 mm for the weights 2.21 g and 21.03 g respectively. Maximum GSI (gonadosomatic index) value was demonstrated in the month of November with the peak value of 1.23 in males and 20.67 in females. The absolute fecundity varied from 561 to 11,386 eggs and relative fecundity from 914 to 1441 eggs per gram body weight. The average absolute fecundity recorded was 3,851.61 ± 266.61 whereas average relative fecundity was 418.45 ± 19.25 per gram body weight. The chi-square (χ 2) test indicated that there is significant difference (p≤0.05) between the Absolute fecundity in different months. The resultant average sex ratio, male: female was 1:0.8, indicating a significant dominance of males (p < 0.05). The length at first maturity (L50) for females of Triplophysa kashmirensis was estimated at 86 mm.

Diagnostic yield and concordance of image-guided biopsy in musculoskeletal lesions.

Image-guided biopsy is well-established in the diagnosis of musculoskeletal lesions. While several studies have demonstrated a high diagnostic yield in image-guided biopsy, there are no current guidelines around procedural factors such as number of cores. Furthermore, there have been mixed results regarding which lesions are more favourable to a diagnostic biopsy. We wanted to evaluate diagnostic yield and concordance for image-guided biopsies for musculoskeletal lesions. The null hypothesis was that there are no controllable factors that contribute to positive yield. Retrospective review of consecutive patients who underwent image-guided biopsy at a large teaching hospital for musculoskeletal lesions discussed at the sarcoma multi-disciplinary meeting. The formal biopsy histology report was evaluated, and biopsies were considered diagnostic or non-diagnostic. In those that had subsequent surgery (by wide excision or open biopsy), final and initial histology was compared and biopsies were considered concordant or not. Overall diagnostic yield and concordance were calculated. Statistical analysis was performed with Stata 13.0 (StataCorp). Over the 14-year period, 429 biopsies were included. Diagnostic yield was 85% and concordance was 100%. No cases of malignant lesions were initially called benign on biopsy. One biopsy had a complication (0.2%). Factors associated with higher diagnostic yield included soft tissue versus bone lesions, three or more cores and longer total specimen length. Factors that were not associated included core size, use of FNA cytology, gender, age, benign versus malignant, anatomic location and lesion appearance. The null hypothesis is rejected. The main predictor of diagnostic biopsy was total specimen length, independent of number of cores taken. Three or more cores and longer cores are optimal, though these factors are influenced by lesion biology and not always able to be controlled.

Endoscopic ultrasound-guided liver biopsy using a single-pass, slow-pull technique with a 19-G Franseen tip fine-needle biopsy needle: A prospective study.

Endoscopic ultrasound-guided liver biopsy (EUS-LB) is considered to be safe and effective. Commonly a 19-G fine-needle aspiration or biopsy needle is used. But, the results vary with different techniques that are used. Herein, we report the results of liver biopsy with a single-pass, three actuations (1:3) using the slow-pull technique. In this prospective study, 50 consecutive patients with indications for liver biopsy underwent EUS-LB with a 19-gauge fine-needle biopsy (FNB) needle from both right and left lobes. The primary outcome was the adequacy of the specimen for histological diagnosis. Total specimen length (TSL), longest specimen length (LSL), complete portal tracts (CPTs) and comparison of these outcomes between the left lobe and right lobe specimens were secondary outcomes. Adverse events (AEs) were also measured during this study. Adequate tissue for histological diagnosis was obtained in all 50 patients (100%). The median number of CPTs was 32.5 (range, 11-58), while the median of TSL was 58mm (range, 35-190) and the median LSL was 15mm (range, 5-40). There was no significant difference in CPTs, TSL and LSL between left and right lobe biopsies. There was no major complication; one of the patients (2%) had bleed from the duodenal puncture site, which was managed endoscopically without the need for blood transfusion. Endoscopic ultrasound-guided liver biopsy using a 19-gauge Franseen tip needle with a single pass, three actuation (1:3) and slow-pull technique provides adequate tissue yield and has a good safety profile.

EUS-guided versus percutaneous liver biopsy: A comprehensive review and meta-analysis of outcomes.

EUS-guided liver biopsy (EUS-LB) has gained momentum in recent years, especially with availability of newer needle designs. Given the emerging comparative data on EUS-LB with second-generation needles and percutaneous LB (PC-LB), we conducted a systematic review and meta-analysis to compare the safety and efficacy of the two techniques. We searched multiple databases from inception through November 2021 to identify studies comparing outcomes of EUS-LB and PC-LB. Pooled estimates were calculated using a random-effects model, and the results were expressed in terms of pooled proportions and odds ratio (OR) along with relevant 95% confidence intervals (CIs). Five studies with 748 patients were included in the final analysis. EUS-LB was performed in 276 patients and PC-LB in 472 patients. Across all studies, PC-LB had an overall higher diagnostic accuracy than EUS-LB, 98.6% confidence interval (CI: 94.7-99.7) versus 88.3% (49.6-98.3), OR: 1.65, P = 0.04. On assessing data from randomized controlled trials, there was no difference between the two. While pooled diagnostic adequacy and overall adverse events were not significantly different between PC-LB and EUS-LB, the former was superior in terms of the mean number of complete portal tracts (CPT) and total specimen length. PC-LB and EUS-LB produce similar results. PC-LB allows obtaining longer samples and more CPT. Further studies are needed to see if these trends hold up as more providers begin to perform EUS-LB.

Estimation of length-weight relationship and condition factor of the mahseer fingerlings, Neolissochilus hexagonolepis (McClleland, 1839) of River Ghish in Darjeeling Himalaya of West Bengal, India

A Length-Weight Relationship (LWRs) and Condition Factor (K) of Neolissochilus hexagonolepis (McClelland, 1839) fingerlings collected from three adjoining sites of River Ghish, Darjeeling Himalaya, West Bengal, India was studied. A total of 90 specimens were collected during November 2019 and total length-weight data was measured. The total length of specimens studied ranged from 4.0 to 5.9 cm while, the total weight ranged from 0.54 to 1.92 g. Linear regression analysis was used to calculate the degree of relationship between total length and total weight. The Coefficient of Determination (r2) value ranged from 0.976 to 0.974 exhibiting a highly significant correlation (p≤0.001) between length and weight. Estimates of parameter b ranged from 2.893 to 2.926 suggesting negative allometric growth, while estimates of parameter a ranged from 1.12 x 10-5 to 1.29 x 10-5, for three river sites. The overall estimate of Condition Factor (K) indicated increasing growth pattern along with the length of fingerlings. Thus, the data obtained will complement the efforts to understand the biology of these stage specific fish species and will provide useful information for its culture in confined condition.

Study on Condition Factor and Hepatosomatic Index of Bagrus bayad (FORSSKAL, 1775) and Synodontis nigrita (VALENCIENNES, 1840) from Kangimi Reservoir, Kaduna State, Nigeria

A study was conducted to determine the condition factor and hepato-somatic index of Bagrus bayad and Synodontis nigrita in a reservoir. The body weight and total length of specimens collected was used for condition factor determination. The range of condition factor for Bagrus bayad was from 0.972 to 2.118. Condition factor variation for Synodontis nigrita was between Synodontis nigrita and 3.050. The monthly condition factor values variation was significant at P<0.05. There was significant variation between male and female condition factor. Seasonal fluctuation in both species was not significant. Hepato-somatic index for Bagrus bayad changed from 1.772 to 4.132 to 1.772. That of Synodontis nigrita was within the range of 1.304 and 2.299. . Hepato-somatic index varied significantly at P<0.05. Sexual hepato-somatic index difference was not significant. Bagrus bayad hepato-somatic index seasonal difference was not significant. The dry and rainy season difference was for Synodontis nigrita was significant. The recommended range of condition factor is above the range obtained in the present study.

Fillet Quality and Gut Content Analysis of Parachanna obscura and Clarias agboyiensis

Nigeria waters are rich with a variety of fish species but only very feware cultured and available for consumption. This study was conducted toknow the fillet quality, gut content and condition of Parachanna obscuraand Clarias agboyiensis in Nigeria using Igbokoda river as a referencebecause it is a the major fishing site in the nation. Studies were conductedon the viscera somatic index based on the organ weight and the bodyweight of the fish and the food item consumed by Parachanna obscura andClarias agboyiensis between May to October, 2019 to infer on the filletquality and gut content of P. obscura and C. agboyiensis in the water bodyrespectively. A summary of food items that constituted the diet of Clariasagboyiensis are Baccillariophyta, fish, fat droplets, dinoflagellate, insectand Chlorophyta which constituted the most important food items bothoccurring in all stomachs containing food. The fishes has more muscle thanthe viscera organs which indicate that the weight of the fish before dressingout is higher than the weight of the fish after dressing out. This is suggestiveof a good quality of food fish. There was a significant correlation betweenbody weight and total length of specimens found in this study. Increasesin total length resulted in corresponding increases in body weight. Theresult for the condition factor showed was below the expected or standardvalue (K = 1) which shows this species was not in favorable environmentalcondition. It is therefore necessary to allow phytoplanktons grow well inwater body to increase availability of food items to Parachanna obscuraand Clarias agboyiensis. P. obscura and C. agboyiensis are also good foodfishes of a high fillet quality. They are omnivorous feeders therefore havingpotentials for aquaculture.

Determination of Maturity and reproductive cycle of Small Spotted Catshark Scyliorhinus canicula (Linnaeus, 1758)(Scyliorhinidae: Elasmobranchii) From the Syrian marine water

This study was carried out in the Marine Sciences Laboratory of Agriculture Faculty at Tishreen University, in collaboration with the Higher Commission for Scientific Research, on the Small Spotted Catshark Scyliorhinus canicula (Linnaeus, 1758) in the Syrian marine water (Eastern Levant of Mediterranean sea); From Rass Albassit northward ( 35° 55  N), to the Lebanese borders southward (°34 50´ N). During the period January 2012 to September 2013. 417 specimens (231 females, 186males) were collected at depths 50-250 m, from sandy or sandy-muddy bottoms by different fishing gears; mainly hook sub bottom. S. canicula suffers an overfishing into the Syrian marine water. The highest fishing quantity was during spring and summer. The total length of specimens ranged from 225 to 515 mm TL, and weighed from 22 - 380 g. Smallest specimens matured of males and females were 355, 350 mm, respectively. The total length ranged from 355 -500 mm TL for adult males, and 350 -515 mm TL for adult females. S. canicula is an oviparous species. The largest yolky oocytes diameter was 12 mm, and weighed 1.3 g. The ripe oocytes is covered and ovulated as an egg capsule. The length of egg capsules ranged from 42 -50 mm, their width from 16-18 mm, and their mass reached to 4.8 g.

EUS-guided fine-needle liver biopsy in pediatric patients using a modified technique with one-pass, one-actuation wet suction

Liver biopsy (LB) can be a valuable tool to determine the etiology of pediatric liver disease. There is limited data of the role of EUS-LB in children. This study evaluated the efficacy and the safety of a modified technique (M)LB in cases at high risk of bleeding or obese children. In addition, the tissue yield of EUS-(M)LB and percutaneous (PC) approach were compared. A retrospective analysis was performed, comparing EUS-(M)LB and PC-LB in children at a tertiary referral center. All consecutive children referred for PC-LB and EUS-LB who had an unexplained liver test abnormality after exclusion of biliary disorders from March-2017 to August-2018 were included. EUS-(M)LB consisted of a one pass wet suction technique using a 19-gauche core needle. A comparison was performed between total specimen length (TSL) and the number of complete portal triads (CPTs). The cohort included 28 EUS-(M)LB and 28 PC-LB pediatric cases. The median (IQR) age was 14.5 years (13.4-16). The median TSL was 8.6 (5.8-9.6) in EUS-(M)LB cases and 7 cm (7-9) in PC-LB cases (P =0.788). The maximum intact specimen was 2.8 cm (EUS-(M)LB) and 1.6 cm (PC-LB) (P =0.009). The mean (SD) number of CPTs per sample was 28.2 (7.3) and 11.6 (2.1), respectively (P =0.001). Adverse events included once case of self-limited abdominal pain in the PC-LB group. EUS-(M)LB has the potential to be a safe and effective alternative diagnostic modality when compared to PC-LB, to evaluate children with unexplained liver test abnormalities who undergo EUS to evaluate biliary disorders.

Comparison of Short-term Results after Laparoscopic Complete Mesocolic Excision and Standard Colectomy for Right-Sided Colon Cancer: Analysis of a Western Center Cohort.

PurposeLaparoscopic complete mesocolic excision (CME) right colectomy is a technically demanding procedure infrequently employed in Western centers. This retrospective cohort study aims to analyze the safety of laparoscopic CME colectomy compared to standard colectomy for right-sided colon cancer in a Western series.MethodsProspectively collected data from 60 patients who underwent laparoscopic CME right colectomy were compared to the ones of 55 patients who underwent laparoscopic standard right colectomy.ResultsNo differences in clinical characteristics were observed between the CME and standard right colectomy groups. No differences were demonstrated in terms of blood loss (P = 0.060), intraoperative complications (P = 1), conversion rate (P = 0.102), and operative time (P = 0.473). No deaths were observed in either group, while complication rate was 40.0% in the CME and 49.1% in the standard group (P = 0.353). Severe complications occurred in 10.0% vs. 9.1% (P = 0.842), redo surgery in 5.0% vs. 7.3% (P = 0.708), and unplanned readmission in 5.0% vs. 5.5% (P = 1) after CME and standard colectomy, respectively. A significant difference in favor of CME was observed in the total length of specimen (P < 0.001), proximal (P = 0.018), and distal margins (P = 0.037). The number of lymph nodes harvested was significantly higher in the CME group (27 vs. 22, P = 0.037).ConclusionIn Western series, where patients have less favorable clinical characteristics, laparoscopic CME allows to obtain better quality surgical specimens and comparable short-term outcomes compared to standard right colectomy.

Intraspecific dental variations in the deep-sea shark Etmopterus spinax and their significance in the fossil record

An important character on several taxonomic levels for shark identification is the tooth morphology. Sharks show a variety of highly specialized dentitions reflecting adaptations to their feeding habits. Intraspecific variation of tooth morphology such as sexual or ontogenetic dimorphism is poorly known in many species, even though tooth morphology plays a decisive role in the characterization of the fossil record of sharks, which comprises mostly fossil teeth. Here we analyzed the dentition of 40 jaws of the Velvet Belly Lantern Shark Etmopterus spinax and identified ontogenetic and sexual dimorphic characters such as total number of teeth, number of upper teeth, cusplet numbers in upper jaw teeth and width of lower jaw teeth. Dimorphic characters may reduce intraspecific competition for food, as E. spinax segregates by sex and size and may allow for identifying the male sex. The lower jaw tooth height, a sexually non-dimorphic character, was used to re-calculate the total length of specimens, which represents the first such approach for a squaliform shark. Results derived from the extant E. spinax are subsequently applied to fossil Etmopterus sp. teeth (Miocene) to gain individual information such as sex or size, but also characterize the extinct population from the excavation site by a size distribution profile in comparison to data from extant populations. This approach indicates the presence of multiple ontogenetic stages in the extinct population.

Endoscopic ultrasound-guided parenchymal liver biopsy: a systematic review and meta-analysis

Endoscopic ultrasonography (EUS)-guided liver biopsy is a novel technique to obtain adequate liver samples for diagnosis of liver parenchymal diseases. There are studies that have evaluated the feasibility and safety of EUS-guided parenchymal liver biopsy (EUS-LB), however, factors that can influence specimen quality are yet to be determined. Our aim was to determine the diagnostic accuracy of EUS-LB and evaluate factors associated with specimen quality. We performed a detailed search of PubMed/MEDLINE and Web of Science™ databases to identify studies in which results of EUS-guided liver parenchymal biopsies were reported published up to July 2020. A random effects model was used to estimate pooled values (mean ± SE) for total specimen length (TSL) and complete portal tracts (CPT). Subgroup analyses were applied to find out the procedural factors associated with better specimen quality using Cochran's Q test. A total of 10 meta-analyses were done focusing on international studies. Total of 1326 patients who underwent EUS-LB. EUS-LBs performed for suspicion of parenchymal liver disease. Pooled mean values for TSL and CPT with subgroup analyses. Twenty-three studies with a total of 1326 patients were included in our meta-analysis. Overall pooled mean TSL and CPT were 45.3 ± 4.6mm and 15.8 ± 1.5, respectively. In subgroup analysis, core biopsy needles proved to better in terms of CPT than fine-needle aspiration needles (18.4 vs 10.99, p = 0.003). FNB with slow-pull or suction technique provided a similar TSL (44.3 vs 53.9mm, p = 0.40), however, slow-pull technique was better in terms of CPT (30 vs 14.6, p < 0.001). Heterogeneity was present among the studies. Another limitation is the low number randomized control trials. EUS-guided parenchymal liver biopsy is a good alternative to other methods of liver sampling. Using FNB needles with a slow-pull technique can provide better results.

S0948 EUS-Guided Liver Biopsy in Pediatric Patients Compared to Percutaneous Liver Biopsy: Case-Matched Study

INTRODUCTION: EUS–modified liver biopsy (EUS-MLB) can be a valuable tool in determining the etiology of pediatric liver disease. Liver biopsies (LB) traditionally have been performed percutaneously (PC). However, data is limited in the role of EUS-MLB in children. We evaluated the efficacy and the safety of a modified technique (MLB) in pediatric patients. Additionally, we aimed to compare tissue yield of the EUS-MLB and PC approaches. METHODS: A retrospective analysis of EUS-MLB in pediatric patients with unexplained liver function test abnormalities after the exclusion of biliary obstruction in a tertiary referral center from march-2017 to August-2018 was completed. All pediatric patients were referred for EUS-MLB and PC-LB. EUS-MLB consists in a one pass wet suction technique using 19g core needle (Figure 1). Comparisons of total specimen length (TSL), intact specimen length (ISL) and the count of complete portal triads (CPTs) between the groups were done using student’s T-test. RESULTS: There were 7 EUS-MLB and 7 PC-LB pediatric cases (11/14, 78.0% male). The median (IQR) age was 14.5 years (13.4–16.0). The median of the TSL was 8.6 cm (IQR 5.8–9.6) in EUS-MLB cases and 7.0 cm (IQR 7–9) in PC-LB cases (P = 0.05). The maximum intact specimen was 5.9 cm (EUS-MLB) and 2.2 cm (PC-LB) (P = 0.05). The mean (SD) number of CPTs per sample was 28.2 (7.3) and 11.6 (2.1), respectively (P = 0.05). Patient diagnoses included no pathology (3/14, 21.4%), non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (6/14, 42.8%), hepatitis C infection (1/14, 7.1%), drug induced liver injury (2/14, 14.3%), autoimmune hepatitis (1/14, 7.1%) and intrahepatic cholestasis (1/14, 7.1%). Adverse events were uncommon (1/14, 7.1%) and included self-limited abdominal pain in the PC-LB group. CONCLUSION: EUS-MLB was shown to have higher numbers of TSL, ISL and CPTs when directly compared to PC-LB. It has the potential to be a safe and more effective alternative approach in the evaluation of pediatric patients with unexplained liver function test abnormalities who undergo EUS to evaluate biliary complications.Figure 1.: Live view of parenchymal tissue obtained via EUS.

Endoscopic Ultrasound-Guided, Percutaneous, and Transjugular Liver Biopsy: A Comparative Systematic Review and Meta-Analysis.

Background/AimsPercutaneous liver biopsy (PCLB) or transjugular liver biopsy (TJLB) have traditionally been performed to obtain a sample of hepatic tissue; however, endoscopic ultrasound-guided liver biopsy (EUSLB) has become an attractive alternative. The aim of this study was to compare the efficacy and safety of EUSLB, PCLB, and TJLB. MethodsSearch strategies were developed in accordance with PRISMA and MOOSE guidelines. Major outcomes included the following: adequacy of biopsy specimens (i.e., complete portal triads [CPT], total specimen length [TSL] in mm, and length of longest piece [LLP]) in mm), and rate of adverse events. Only studies comparing all biopsy approaches (i.e., EUSLB, PCLB, and TJLB) were included. ResultsFive studies (EUSLB [n=301]; PCLB [n=176]; and TJLB [n=179]) were included. Biopsy cumulative adequacy rates for EUSLB, PCLB, and TJLB were 93.51%, 98.27%, and 97.61%, respectively. Based on the subgroup analysis limited to EUS biopsy needles in current clinical practice, there was no difference in biopsy adequacy or adverse events for EUSLB compared to PCLB and TJLB (all p>0.050). A comparison of EUSLB and PCLB revealed no difference between specimens regarding both CPT (p=0.079) and LLP (p=0.085); however, a longer TSL (p<0.001) was observed. Compared to TJLB, EUSLB showed no difference in LLP (p=0.351), fewer CPT (p=0.042), and longer TSL (p=0.005). ConclusionsEUSLB appears to be a safe, minimally invasive procedure that is comparable to PCLB and TJLB regarding biopsy specimens obtained and rate of adverse events associated with each method.

First data on habitat preference, diet and length-weight relationship of Gobius incognitus Kovačić &amp;amp; Šanda, 2016 (Pisces: Gobiidae)

In this work, we present first data on biological and ecological aspects of Gobius incognitus from specimens from the Ionian Sea (central Mediterranean Sea). In particular, we provided first data on habitat preference, diet and length-weight relationship of G. incognitus on material with confirmed species identity. The species preferred “mixed bottom” (sand and rocks), where it reached relatively high abundances. The diet analysis showed that G. incognitus is a generalist and opportunistic feeder. However, small benthic crustaceans were the most important prey group. The mean total length of specimens was 6.72 ± 1.85 cm and the growth was positive allometric.

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

Background and study aims We compared the diagnostic yield and specimen adequacy in EUS-guided parenchymal biopsies between two types of EUS 19 G core needles. Patients and methods This is a retrospective study of 420 patients at two tertiary medical centers in Florida with unexplained abnormal liver associated tests were referred for EUS evaluation of biliary obstruction and pancreatic pathology. EUS-guided liver biopsy (EUS-LB) was performed at the same session after biliary obstruction was excluded. We compared intact specimen length (ISL), total specimen length (TSL), complete portal triads (CPT) and adverse events (AE). Welch’s T and Tukey tests were used for ISL, TSL and CPT. Results A total of 210 patients underwent EUS-LB using a Franseen needle, 210 patients using a fork-tip needle. Median patient age was 52 years (15.63) and 238 (56.7 %) were female. The fork-tip needle had a mean ISL of 2.7 (1.1 SD) cm, TSL of 6 cm (2.1 SD), and mean 19.5 CPT (8.5 SD) Abdominal pain occurred in 35 patients (17 %) post-procedure and was managed with supportive care. Two patients required intravenous (IV) narcotic administration. Subcapsular hematomas occurred in 1 (0.5 %) patients. The Franseen needle had a mean ISL of 3.1 cm (1.3 SD), TSL of 6.5 cm (2.6 SD), and mean of 24 CPT (8.8 SD). Abdominal pain occurred in four patients (2 %) post-procedure, which resolved in all patients after IV narcotic administration. Subcapsular hematomas occurred in 1 (0.5 %) and bile leak in 1(0.4 %) patients. Conclusions Use of the Franseen needle resulted in better liver core samples than that obtained with a fork-tip needle.

How Can We Optimize Tools and Techniques for Endoscopic Ultrasound–Guided Liver Biopsy?

How Can We Optimize Tools and Techniques for Endoscopic Ultrasound–Guided Liver Biopsy?

P023 THE ASSOCIATION BETWEEN BIOLOGIC USE AND SPECIMEN LENGTH IN CROHN’S DISEASE

Abstract Introduction Despite advances in medical management, including the use of biologic agents, up to 80% of Crohn’s patients (CD) ultimately require operative intervention. Additionally, these patients are at risk for additional operative intervention within their lifetime. Given the risk of short bowel syndrome secondary to multiple bowel resections, conservation of bowel length is of paramount importance. A common yet unproven belief in the gastroenterology community is that intensive preoperative medical therapy might reduce the length of bowel removed at surgery. In this study, we compared specimen length in CD patients treated or not treated with biologic agents before surgery. Objective To determine if there is an association between biologic use and reduced specimen length after bowel resection. Methods Prospectively generated clinical profiles on consecutive CD patients undergoing their first ileocolic or small bowel resection between November 1999 to July 2019 were reviewed. Patients were classified into 2 groups: Group A patients were treated with biologic agents at any time before surgery while Group B patients had never received a biologic agent. Specimen length was determined by review of pathology reports. In patients with multi-segment resections, the sum of the specimens was recorded. The means of the two groups were compared using Students t test. Results The study cohort of 392 patients had a mean age of 36.2 (SD 15.9) years and included 53% males. Group A included 247 (63%) patients and Group B included 145 (37%) patients. Groups were comparable in terms of background demographics with the exception of age, use of preoperative immunomodulator therapy, and medical intractability as an indication for surgery (p value 0.01, &amp;lt;0.01, 0.02 respectively) The mean specimen length in Group A was 29.1cm compared to 29.9cm in the Group B (p=0.68). A subgroup analysis of ileocolic resections and small bowel resections was completed. Within the ileocolic group, there was no significant difference in length between groups with respect to the total specimen length (p=0.92), colonic portion (p=0.15), and small bowel portion (p=0.67). Analysis of small bowel resection specimens also found no difference in length between the groups (p=0.63). Conclusions The use of biologics in CD was not associated with reduced specimen length in ileocolic resections and in small bowel resections