Rapid versus slow puncture in endoscopic ultrasound-guided liver biopsy: a multicenter randomized crossover trial

Background: Endoscopic ultrasound-guided liver biopsy (EUS-LB) is increasingly used for hepatic histologic assessment; however, optimal technical approaches remain undefined. This prospective, multicenter clinical study aimed to compare tissue acquisition and safety between the rapid and slow puncture techniques for EUS-LB. Methods: This was a multicenter randomized crossover study. Patients undergoing EUS-LB were randomized to receive both rapid puncture and slow puncture techniques in alternating sequence during the same session. The primary outcomes were the number of complete portal tracts (CPTs) and total specimen length (TSL). The secondary outcomes were diagnostic adequacy and adverse events. Linear mixed models and generalized linear mixed models were used to evaluate the technical performance. Results: A total of 62 specimens were analyzed. Compared with the conventional slow puncture technique, rapid puncture significantly increased CPTs (mean difference 2.39; 95%CI 1.50-3.27), as well as TSL (mean difference 15.19 mm; 95%CI 9.65-20.74), with corresponding improvements in diagnostic adequacy (odds ratio 16.27, 95%CI 2.41-109.97). Time period and center were not statistically significantly associated with the outcomes. No severe adverse events were reported. Conclusion: The modified rapid puncture technique was associated with improved specimen quality in EUS-LB. These findings support its potential utility in clinical practice; however, further validation in larger and more diverse populations is warranted.