Post written by Kenneth J. Chang, MD, from the Digestive Health Institute, Chao Family Comprehensive Digestive Disease Center, University of California, Irvine.

These are 2 cases of EUS-guided liver biopsy where there was active blood flow within the needle tract prior to needle withdrawal. After waiting 2-3 minutes, we saw persistent flow, raising concerns that complete needle withdrawal would lead to significant bleeding through the liver capsule. We therefore performed a novel technique of EUS-guided blood patch delivery by re-inserting the stylet and pushing the distal 25% of the needle contents back into the needle tract. This created a mechanical occlusion of blood flow at the patch, so the needle could be safely withdrawn as well as expedited complete cessation of flow in the tract, thereby preventing post liver biopsy hemorrhage. Both patients did well post procedure without adverse events. Adequate liver tissue was obtained for histologic diagnosis without the need for additional passes. 

The field of endohepatology is rapidly emerging with a combination of multiple diagnostic modalities, such as EUS-guided shear wave elastography, EUS-guided porto-systemic pressure gradient measurement, and EUS-guided liver biopsy. Among the main concerns for those who practice endohepatology is the potential risk of post-biopsy hemorrhage. This technique represents a potential salvage technique that may be helpful in situations where blood flow is active within the needle tract prior to needle withdrawal. 

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