Interventional Endoscopy

6 - One versus Three Needle Actuations for EUS-Guided Liver Biopsy: A Prospective Randomized Trial

Monday, October 8
9:30 AM - 9:42 AM
Location: Terrace Ballroom (level 400)

Category: Interventional Endoscopy
Rafael Ching-Companioni, MD1, Amitpal S. Johal, MD1, Bradley Confer, DO1, Harshit S. Khara, MD, FACG1, Erin Forster, MD, MPH2, David L. Diehl, MD1
1Geisinger Medical Center, Danville, PA; 2Medical University of South Carolina, Charleston, SC

Award: Fellows-in-Training Award (Interventional Endoscopy Category)

Introduction: Liver biopsy remains an important tool for the evaluation and management of liver disease. Over the last years, several reports have validated endoscopic ultrasound-guided liver biopsy (EUS-LB) to be a safe and efficient technique for achieving parenchymal liver biopsy. Generally, a 19G EUS aspiration (FNA) or a core (FNB) needle are used for biopsy, but recent work has suggested that the core needle is superior. There is clinical experience that 1 pass 1 actuation may be enough to obtain a satisfactory specimen. However, this has not been prospectively tested. 

Methods: This was a prospective randomized trial comparing the specimen adequacy using two different EUS-LB techniques. Forty patients undergoing EUS-LB were randomized to either 1 pass, 1 actuation (“1:1”) or 1 pass, 3 to-and-fro fanning needle motions technique (“1:3”). A transgastric pass and transduodenal pass were completed in every patient, with heparin priming of a 19G FNB needle and full suction. The total aggregate specimen length and length of the longest piece were determined prior to histological tissue processing using computer-assisted image analysis. The number of complete portal tracts per specimen was also assessed. Statistical analyses were performed using SPSS version 21. One-way analysis of variance (ANOVA) and Tukey correction were used for statistical analysis, P < 0.05 considered to be significant for continuous data and categorical data using chi-square test or Fisher exact test.

Results: Forty patients were randomized to 1:1 or 1:3 techniques. Median age was 52.5 yr (18-81); 52.5% were female. Demographic data (table 1) and indications for EUS-LB were similar. Biopsies were adequate for pathological interpretation in all cases. Biopsies with the 1:3 technique compared to 1:1 yielded longer aggregate specimen length (12.85 cm [4.02] vs. 6.89 cm [1.86]; P >9mm (6.2 [2.35] vs. 2.85 [0.75]; P <0.001*), and more complete portal triads (24.31 [6.00] vs.16.73 [5.15] P <0.001*) (Table 2). Percentage of patients experiencing pain after the liver biopsy was similar for both techniques (Table 3).

Discussion: EUS-LB using 1:3 technique delivers longer total aggregate specimen length and portal count than the 1:1 technique without significant change in the length of the longest piece. These results indicate that the technique of using 3 to-and-fro fanning needle motions for EUS-LB gives better tissue yields than a single needle throw

Patient demographics
Quantitative outcomes comparing 1:1 to 1:3 techniques
Pain after procedure and need for analgesia

Disclosures:
Rafael Ching-Companioni indicated no relevant financial relationships.
Amitpal Johal: Boston Scientific – Consultant.
Bradley Confer indicated no relevant financial relationships.
Harshit Khara: Boston Scientific – Consultant.
Erin Forster indicated no relevant financial relationships.
David Diehl: Boston Scientific – Consultant.

Rafael Ching-Companioni

Geisinger Medical Center
Danville, Pennsylvania

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