Single pass, 1 needle actuation versus single pass 3 actuation technique for EUS-guided liver biopsy: a randomized prospective trial (with video).

BACKGROUND AND AIMS: Several reports have validated endoscopic ultrasound-guided liver biopsy (EUS-LB) as safe and effective. Nineteen-gauge EUS aspiration (fine-needle aspiration [FNA]) or core (fine-needle biopsy [FNB]) needles are used, but different needle techniques can yield variable outcomes. Some data shows 1 pass (single liver puncture) with 1 actuation (one to-and-fro needle movement) may be enough to obtain a satisfactory specimen. However, there has not been a head-to-head comparison of single versus multiple needle actuations for EUS-LB.

METHODS: This was a prospective randomized trial of EUS-LB in 40 patients comparing tissue yields and adequacy using 1 pass, 1 actuation (1:1) versus 1 pass 3 actuations (1:3) of an FNB needle. Primary outcome was number of complete portal triads (CPT). Secondary outcomes were length of the longest piece, aggregate specimen length, number of cores >9 mm, and adverse events (AEs). Computerized randomization determined selection (either 1:1 or 1:3 with fanning technique). Sample lengths were measured before pathologic processing.

RESULTS: Both groups had similar demographics and indications for EUS-LB. All biopsies were adequate for pathological interpretation. Compared with 1:1, biopsies with 1:3 yielded more CPT (mean [SD] 17.25 [6.2] vs 24.5 [9.88]; p <0.008) and longer aggregate specimen length (6.89 cm [1.86] vs 12.85 cm [4.02]; p <0.001). AEs were not statistically different between the techniques. No severe AEs were noted.

CONCLUSION: EUS-LB using 1:3 technique produced longer liver cores with more CPT than the 1:1 technique with an equivalent safety profile. Two needle passes are more likely to provide tissue adequacy according to American Association for the Study of Liver Diseases (AASLD) guidelines.