Comparing a 19-gauge fine-needle biopsy needle with a 22-gauge fine-needle biopsy needle for EUS-guided liver biopsy sampling: a prospective randomized study

Background and Aims

The use of endoscopic ultrasound-guided liver biopsy (EUS-LB) is being increasingly utilized. We performed a prospective randomized trial to compare specimen adequacy of 19-gauge to 22-gauge Franseen tip (FNB) needle for EUS-LB.

Methods

Forty-two consecutive patients referred for EUS-LB were prospectively randomized to 19-gauge or 22-gauge FNB. In cases of macroscopically inadequate specimen with the 22-gauge, an additional pass with the 19-gauge was done. Bilobar EUS-LB was performed with heparinized wet suction using 1 pass, 3 actuations per lobe. Descriptive statistics were computed for all variables.

Results

Biopsies were done for abnormal liver enzymes in 95.5% of cases, with 57% females and average age of 51. Five 22-gauge FNB patients had macroscopically inadequate specimen and required an additional 19-gauge FNB biopsy. Median pre-processing length of the longest tissue core was 21.5 +/- 6.3 mm with 19-gauge FNB compared to 9.4 +/- 5.5 mm with 22-gauge FNB (p < 0.001). Post-processing specimens were significantly longer with 19-gauge than 22-gauge FNB (17.4 mm vs. 6.8, p < 0.001). There were no adverse events (AEs) and post-procedure pain/discomfort was similar in both groups (14% for 19-gauge vs 10% for 22-gauge, p=0.99).

Conclusion

19-gauge FNB liver core biopsies are superior to 22-gauge FNB in terms of length of longest core and aggregate specimen length. There is considerably more fragmentation of the 22-gauge cores during tissue processing. There was no increased post-procedure pain or AEs with the 19-gauge. A 19-gauge FNB is preferred to 22-gauge FNB for EUS-LB.