EUS-guided fine-needle core liver biopsy using a novel 19G needle with modified one pass, one actuation wet suction technique

Abstract Background and Aims EUS-guided fine-needle core biopsy is a safe and effective technique for diagnosis of focal liver lesions. However, data are limited in its role in parenchymal disease. We evaluated the utility of EUS-guided parenchymal liver biopsies (EUS-LB) with a modified one pass wet suction technique (EUS-MLB) in patients with unexplained increase in liver associated tests. Methods We retrospectively evaluated the safety and efficacy of EUS-MLB in patients referred for EUS to evaluate for biliary obstruction and pancreatic disorders, but with associated unexplained liver tests. EUS-MLB was performed during the same session after biliary obstruction was excluded. Results One hundred sixty-five consecutive patients underwent EUS-MLB. The median (interquartile range [IQR]) age was 52 years (42, 65). Sixty-eight patients (41%) were male. The median (IQR) of the maximum intact core tissue length was 2.4 cm (1.8, 3.5). The median (IQR) total specimen length (TSL) was 6 cm (4.3, 8). The median (IQR) number of complete portal tracts (CPT) per TSL was 18 (13, 24). The mean number of CPT per sample length was 7.5 cm. Adverse events were uncommon (1.8%), and included abdominal pain and self-limited hematoma. Conclusion EUS-guided fine-needle biopsy using a novel 19G core needle with a modified one pass one actuation wet suction technique (EUS-MLB) is a safe and effective way to evaluate patients with unexplained liver tests abnormalities who are undergoing EUS for exclusion of biliary obstruction.