S2186 Comparative Performance of Fork-Tip and Franseen Fine-Needle Biopsy Systems in Endoscopic Ultrasound-Guided Liver Biopsy: A Systematic Review and Meta-Analysis

Introduction: Procedural standardization in endoscopic ultrasound-guided liver biopsy (EUS-LB) is crucial for obtaining core biopsy specimens that ensure accurate diagnosis. We conducted a systematic review and meta-analysis to compare the diagnostic performance and safety of the Fork-tip and Franseen fine-needle biopsy (FNB) systems in EUS-LB, focusing on diagnostic yield, specimen quality, and adverse events. Methods: A comprehensive search of multiple electronic databases, including PubMed, EMBASE, and Web of Science (from inception to October 2024), was performed to identify studies reporting on EUS-guided liver biopsy using these 2 FNB systems. The primary outcomes included pooled rates of successful diagnosis, number of complete portal tracts (CPTs), total specimen length (TSL), and longest specimen length (LSL). The secondary outcome was to estimate the pooled adverse event rates associated with each FNB system. Standard meta-analysis methods were employed using a random-effects model, and heterogeneity was assessed using the I2 index. Results: A total of 34 studies involving 1,815 patients were included. The Fork-tip FNB (SharkCore, Medtronic Corporation, Minneapolis, Minn, USA) was evaluated in 12 study arms, the Franseen FNB (Acquire, Boston Scientific Corporation, Marlborough, Mass, USA) in 33 arms. Our analysis demonstrated the highest diagnostic success rate with the Franseen FNB 19G (96.5%), marginally outperforming the Fork-tip FNB 19G (94.5%). The pooled mean number of complete portal triads (CPTs) was higher for the Franseen FNB 19G (18.33) compared to the Fork-tip FNB 19G (15.7), while the Fork-tip FNB 19G achieved a slightly greater pooled mean total specimen length (TSL) at 51.41 mm versus 47.26 mm for the Franseen FNB 19G. Biopsies targeting both hepatic lobes enhanced diagnostic success rates, CPTs, and TSLs for both needle systems, with the Franseen FNB 19G demonstrating superior diagnostic outcomes. Smaller 22G needles exhibited reduced performance in CPTs, TSL, and diagnostic adequacy, with the Franseen 22G showing the lowest diagnostic success rate (84.8%). Adverse events were rare across all groups, though the Franseen FNB was associated with the highest overall adverse event rate (6.7%). No significant publication bias was identified. Conclusion: In EUS-LB, the 19-gauge Franseen FNB system, with biopsies obtained from both lobes, demonstrated superior diagnostic adequacy compared to other FNB systems.