Endoscopic Ultrasound-Guided Multiple Actuation Liver Biopsy Has Better Adequacy and Lesser Pain with Equal Safety Profile Compared to Percutaneous Route

Aims: Endoscopic ultrasound-guided liver biopsy (EUS-LB) has emerged as an alternative to the percutaneous route (PC-LB). Multiple actuation has the potential to increase yield of specimen. We aimed at comparing sample adequacy and safety of multiple actuation EUS-LB using a modified technique and compared with PC-LB.

Methods: Fifty consecutive EUS-LBs done between July to November 2023 were compared to 100 consecutive historical controls of PC-LB. EUS-LB was performed using a modified technique with 19G Franseen core needle by heparinized wet suction technique. One to two passes were taken with multiple actuations till blood was aspirated into the suction syringe as a dynamic end point. PC-LB was done with 18G biopsy gun and 2 to 4 passes were taken. Outcome measured were total and longest specimen length (TSL and LSL), number of complete portal tracts (CPT), definitive histological diagnosis, postprocedural pain and adverse events (AEs). An adequate specimen was defined as TSL ≥20 mm and CPT ≥11. Only TSL was considered when CPT could not be counted due to cirrhosis.

Results: In EUS-LB mean number of actuation taken per pass were 6.95 (±2.04). The percentage of adequate samples in EUS-LB versus PC-LB were 96% versus 71% (p = 0.0003) and histological diagnosis was possible in 98% versus 89% (p = 0.055). The mean TSL and CPT in EUS-LB versus PC-LB were 7.98 cm (±3.74) versus 4.10 cm (±1.96), p < 0.00001 and 24.32 (±9.60) versus 13.14 (±6.59), p <00001. Postprocedural pain was seen in 6% of EUS-LB group compared to 19% of PC-LB group (p = 0.033). Other AE in EUS-LB versus PC-LB were seen in 4 (needle tract bleeding: 1, postprocedural vomiting: 3) and 6 (hemoperitoneum: 1, subcapsular hematoma: 3, postprocedural vomiting: 2) patients, respectively (p = 0.64).

Conclusions: Modified EUS-LB technique with multiple actuations has better sample adequacy, pain tolerability with comparable safety in comparison to PC-LB.

Publication History

Article published online:
22 April 2024