Adequacy, safety, and technical determinants of a modified EUS-guided liver biopsy sampling technique in patients with or without cirrhosis: a pilot study.

Background and Aims: Technique-related factors of EUS-guided liver biopsy sampling (EUS-LB) as a determinant of specimen yield have not been studied. We used a modified technique to study adequacy, safety, and technical determinants in patients with or without cirrhosis. Methods: EUS-LB was performed with a 19-gauge Franseen-tip needle by wet heparinized suction. One or 2 passes with a variable number of actuations were taken, with an endpoint of the aspiration of blood. Primary outcomes were tissue core adequacy and definitive histologic diagnosis. Secondary outcomes were a correlation between the number and depth of actuations with total specimen length (TSL), longest specimen length (LSL), and adverse events (AEs). Early and late AEs were also accessed. Results: Adequate samples were seen in 48 of 50 patients, and a histologic diagnosis could be achieved in 49 of 50 patients. Mean TSL, LSL, and depth of actuation were 7.98 ± 3.74 cm, 1.89 ± .80 cm, and 4.29 ± .98 cm, respectively. The median number of complete portal tracts was 23 (range, 7-50) and number of actuations was 7 (range, 4-12). The correlation between TSL with number and depth of actuation was r = .71 versus r = .53 and r = .55 versus r = .51 and for LSL was r = .28 versus r = .11 and r = .74 versus r = .55 in noncirrhotic and cirrhotic patients, respectively. No major and 7 (14%) minor AEs were observed. Conclusions: This modified EUS-LB technique resulted in adequate tissue acquisition and is safe in noncirrhotic and cirrhotic patients. Technical factors like the number and depth of actuations determine specimen yield.