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Liver biopsy with three actuations provides superior tissue yields

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PHILADELPHIA — Endoscopic ultrasound-guided liver biopsy using three fanning needle motions provided superior tissue yields than a single needle throw, according to a presentation at the American College of Gastroenterology Annual Meeting.

“Liver biopsy remains the gold standard in the evaluation and management of liver disease,” Rafael Ching-Companioni, MD, from the Geisinger Medical Center in Pennsylvania, said during his presentation. “Recently, several reports have validated liver biopsy to be a safe and effective technique for achieving parenchymal liver biopsy. Our aim was to compare one and three needle actuations.”

Ching-Companioni and colleagues enrolled and randomly assigned 40 patients to undergo endoscopic ultrasound (EUS)-guided liver biopsy with one of two techniques: either one pass and one actuation (1:1) or 1 pass with three to-and-fro fanning needle motions (1:3) into the left and right lobes.

Biopsies performed with the 1:3 technique yielded longer aggregate specimen length (12.85 vs. 6.89 cm; P < .001) and more complete portal triads (24.31 vs. 16.73; P < .001) compared with the traditional 1:1 technique. The longest pieces in each group were of similar lengths.

Specifically, the 1:3 technique yielded more complete portal tracts from the right lobe (12.35 vs. 8; P = .003), although the mean number of complete portal tracts was not significantly different between the two groups for the left lobe (12.15 vs. 9.25).

Ching-Companioni reported no serious adverse events in either group and post-procedural pain was similar for both groups.

“This prospective randomized trial demonstrated that aggregate specimen length, complete portal tracts and tissue adequacy were higher for the three actuations vs. one actuation,” Ching-Companioni said. “Future directions should examine the effect of varying amounts of suction on specimen adequacy and yields.” – by Talitha Bennett

Reference : Ching-Companioni, et al. Abstract 6. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 5-10, 2018; Philadelphia.

Disclosure: Ching-Companioni reports no relevant financial disclosures.