Endoscopic ultrasound-guided liver biopsy using a 22G fine-needle biopsy needle and slow pull technique: A tertiary center experience

BACKGROUND: Endoscopic ultrasound-guided fine needle biopsy of the liver (EUS-LB) has emerged as a safe technique to obtain liver tissue for diagnosis of diffuse parenchymal and focal liver diseases. This method is widely accepted as it can overcome numerous shortcomings of percutaneous and transjugular liver biopsy (LB), but the technique is not well studied yet. There is a paucity of literature demonstrating that EUS-LB provides an adequate tissue sample for histologic analysis. Data on the use of 22G fine-needle biopsy (FNB) needle for liver biopsy is scarce. OBJECTIVE: The aim of this study was to review the experience of a large tertiary referral center with EUS-LB and to evaluate the efficacy and safety of the method using a 22G FNB needle and slow pull technique for diffuse parenchymal diseases and focal liver lesions. METHODS: We conducted a retrospective observational study over a three-year period and included all consecutive patients who underwent EUS-LB for diffuse parenchymal disease or focal liver lesions using a 22G Franseen-tip needle and slow pull technique. RESULTS: A total of 72 patients were included in the study, of which 32 were males and 40 were females. The median age was 56.9 years. Adequate biopsy rates, as assessed by pathologists, were achieved in all 72 patients. Malignant disease was found in 55 (76.4%) patients and benign disease in 17 (23.6%). No adverse events were observed during the first 48 hours or within a 30-day follow-up. CONCLUSIONS: Our study illustrates that EUS-guided liver biopsy using a 22G FNB needle provides an adequate specimen for histologic analysis, shorter postprocedural recovery time, and is a safe and effective alternative to conventional methods of liver biopsy. The use of real-time imaging guidance with Doppler also helps to reduce adverse events.