Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background and Aims

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.

Methods

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.

Results

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 58 mm (range, 35–190) and the median LSL was 15 mm (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.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

© Copyright 2020 with Boston Scientific Corporation and its affiliates”

Fig. 3

Similar content being viewed by others

References

  1. Diehl DL, Johal AS, Khara HS,  et al. Endoscopic ultrasound-guided liver biopsy: A multicenter experience. Endosc Int Open. 2015;3:E210-5.

  2. Amarapurkar D, Amarapurkar A. Indications of liver biopsy in the era of noninvasive assessment of liver fibrosis. J Clin Exp Hepatol. 2015;5:314–9.

  3. Ratziu V, Charlotte F, Heurtier A,  et al. Sampling variability of liver biopsy in non-alcoholic fatty liver disease. Gastroenterology. 2005;128:1898–906.

  4. Rathod K, Deshmukh H, Sundaram S, et al. Plugged percutaneous liver biopsy using Tru-cut needle and coils: A retrospective study. Indian J Gastroenterol. 2022;41:424–9.

  5. Schulman AR, Thompson CC, Odze R, Chan WW, Ryou M. Optimizing EUS-guided liver biopsy sampling: Comprehensive assessment of needle types and tissue acquisition techniques. Gastrointest Endosc. 2017;85:419–26.

  6. Mok SRS, Diehl DL, Johal AS,  et al. A prospective pilot comparison of wet and dry heparinized suction for EUS-guided liver biopsy (with videos). Gastrointest Endosc. 2018;88:919–25.

  7. Ching-Companioni RA, Diehl DL, Johal AS, Confer BD, Khara HS. 19 G aspiration needle versus 19 G core biopsy needle for endoscopic ultrasound-guided liver biopsy: A prospective randomized trial. Endoscopy. 2019;51:1059–65.

  8. Pineda JJ, Diehl DL, Miao CL,  et al. EUS-guided liver biopsy provides diagnostic samples compared with those via the percutaneous or transjugular route. Gastrointest Endosc. 2016;83:360–5.

  9. Nieto J, Khaleel H, Challita Y,  et al. EUS-guided fine-needle core liver biopsy sampling using a novel 19-gauge needle with modified 1-pass, 1 actuation wet suction technique. Gastrointest Endosc. 2018;87:469–75.

  10. Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD. Liver biopsy. Hepatology. 2009;49:1017–44.

  11. Cotton PB, Eisen GM, Aabakken L,  et al. A lexicon for endoscopic adverse events: Report of an ASGE workshop. Gastrointest Endosc. 2010;71:446–54.

  12. Johnson KD, Laoveeravat P, Yee EU, Perisetti A, Thandassery RB, Tharian B. Endoscopic ultrasound guided liver biopsy: Recent evidence. World J Gastrointest Endosc. 2020;12:83–97.

  13. Dewitt J, McGreevy K, Cummings O,  et al. Initial experience with EUS-guided Tru-cut biopsy of benign liver disease. Gastrointest Endosc. 2009;69 3 Pt 1:535–42

  14. Gleeson FC, Clayton AC, Zhang L,  et al. Adequacy of endoscopic ultrasound core needle biopsy specimen of non-malignant hepatic parenchymal disease. Clin Gastroenterol Hepatol. 2008;6:1437–40.

  15. Sey MSL, Al-Haddad M, Imperiale TF, McGreevy K, Lin J, DeWitt JM. EUS-guided liver biopsy for parenchymal disease: A comparison of diagnostic yield between two core biopsy needles. Gastrointest Endosc. 2016;83:347–52.

  16. Mohan BP, Shakhatreh M, Garg R, Ponnada S, Adler DG. Efficacy and safety of EUS-guided liver biopsy: A systematic review and meta-analysis. Gastrointest Endosc. 2019;89:238-46.e3.

  17. Patel HK, Saxena R, Rush N,  et al. A comparative study of 22G versus 19G needles for EUS-guided biopsies for parenchymal liver disease: Are thinner needles better? Dig Dis Sci. 2021;66:238–46.

  18. Mok SRS, Diehl DL, Johal AS,  et al. Endoscopic ultrasound-guided biopsy in chronic liver disease: A randomized comparison of 19-G FNA and 22-G FNB needles. Endosc Int Open. 2019;7:E62-71.

  19. Hasan MK, Kadkhodayan K, Idrisov E,  et al. Endoscopic ultrasound-guided liver biopsy using a 22-G fine needle biopsy needle: A prospective study. Endoscopy. 2019;51:818–24.

  20. Rombaoa C, Chen AM. Mo1351 The safety and feasibility of endoscopic ultrasound-guided parenchymal liver biopsy at a large community hospital. Gastrointest Endosc. 2018;87:AB458.

  21. Hashimoto R, Lee DP, Samarasena JB,  et al. Comparison of two specialized histology needles for endoscopic ultrasound (EUS)-guided liver biopsy: A pilot study. Dig Dis Sci. 2021;66:1700–6.

  22. Nieto J, Dawod E, Deshmukh A, Penn E, Adler D, Saab S. EUS-guided fine-needle core liver biopsy with a modified one-pass, one-actuation wet suction technique comparing two types of EUS core needles. Endosc Int Open. 2020;8:E938–43.

  23. Ching-Companioni RA, Johal AS, Confer BD, Forster E, Khara HS, Diehl DL. Single-pass 1-needle actuation versus single-pass 3-needle actuation technique for EUS-guided liver biopsy sampling: A randomized prospective trial (with video). Gastrointest Endosc. 2021;94:551–8.

  24. Shah RM, Schmidt J, John E, Rastegari S, Acharya P, Kedia P. Superior specimen and diagnostic accuracy with endoscopic ultrasound-guided liver biopsies using 19-gauge versus 22-gauge core needles. Clin Endosc. 2021;54:739–44.

  25. Merriman RB, Ferrell LD, Patti MG,  et al. Correlation of paired liver biopsies in morbidly obese patients with suspected nonalcoholic fatty liver disease. Hepatology. 2006;44:874–80.

  26. Bazerbachi F, Vargas EJ, Matar R, et al. EUS-guided core liver biopsy sampling using a 22-gauge fork-tip needle: A prospective blinded trial for histologic and lipidomic evaluation in nonalcoholic fatty liver disease. Gastrointest Endosc. 2019;90:926–32.

  27. Khurana S, Butt W, Khara HS, et al. Bi-lobar liver biopsy via EUS enhances the assessment of disease severity in patients with non-alcoholic steatohepatitis. Hepatol Int. 2019;13:323–9.

Download references

Acknowledgements

We thank the endoscopy staff for their cooperation in the completion of the study.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India

    Praveer Rai, Abdul Majeed, Pankaj Kumar, Mayank Rajput & Amit Goel

  2. Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India

    Ram Naval Rao

Authors
  1. Praveer Rai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Abdul Majeed
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pankaj Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mayank Rajput
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Amit Goel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ram Naval Rao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Praveer Rai.

Ethics declarations

Conflict of interest

PR, AM, PK, MR, AG and RNR declare no competing interests.

Ethics statement

The study was performed conforming to the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

Disclaimer

This is an independent study with independently drawn protocols and conclusions. It has not been authorized or sponsored by Boston Scientific Corporation or its Affiliates.

The authors are solely responsible for the data and the contents of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, the Indian Society of Gastroenterology or the printer/publishers are responsible for the results/findings and content of this article.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rai, P., Majeed, A., Kumar, P. et al. 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. Indian J Gastroenterol 42, 418–424 (2023). https://doi.org/10.1007/s12664-023-01339-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12664-023-01339-7

Keywords

Search

Navigation