Post written by David L. Diehl, MD, FACP, FASGE, from the Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA.

The focus of this study is to further refine the optimal method for EUS-guided liver biopsy. Some reports in the literature utilize a single pass, single-needle throw for obtaining a liver biopsy specimen. However, often there is only a 2-4 cm trajectory of safe needle passage for biopsy. While longer needle throws can obtain longer liver cores, longer passes are sometimes not possible. This study set out to determine if multiple to-and-fro movements of the needle yield more usable liver cores than a single throw.

We used what is currently accepted as the optimal biopsy needle (19G FNB needle) as well as wet suction, which has outperformed dry suction in multiple studies. We prospectively randomized patients undergoing EUS-LB to one pass, single-needle throw (one to-and-fro) to one pass, 3 needle throws. A power analysis found that 40 subjects should be entered into the study: 20 in the 1:3 and 20 in the 1:1.

We found that 3 needle throws yielded more good liver cores than a single throw. The important metrics that were used were number of complete portal triads (CPTs), aggregate specimen length (ASL), and length of the longest piece (LLP). The LLP was comparable between 1 and 3 needle actuations, but CPT and ASL were significantly higher with 3.

There is no need to worry if you cannot find a needle trajectory without blood vessels longer than 2-3 cm. Find a safe trajectory and move the needle back and forth 3 times, instead of a single time. If you are using a 19G FNB needle with wet suction, your yield should be good.

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