A prospective, head-to-head comparison of 2 EUS-guided liver biopsy needles in vivo

Published:October 08, 2020DOI:

      Background and Aims

      Procedural standardization in endoscopic ultrasound-guided liver biopsy (EUS-LB) is necessary to obtain core biopsy specimens for accurate diagnosis. The objective of this study was to directly compare the diagnostic yield of 2 EUS-LB fine-needle biopsy (FNB) systems in vivo.


      In this prospective, single-center study, 108 adult patients undergoing EUS-LB over a 1-year period were included. Each EUS-LB consisted of an EGD, followed by EUS-guided biopsy of the left lobe of the liver sequentially using 2 different 19-gauge needles: the fork-tip (SharkCore) and Franseen (Acquire) FNB systems. Specimens were then reviewed by a GI histopathologist to determine diagnostic adequacy as well as the number of complete portal tracts, specimen length, and degree of fragmentation.


      In 79.4% of cases, the fork-tip FNB system yielded a final diagnosis compared with 97.2% of the Franseen FNB specimens (P < .001). The mean number of complete portal tracts in the fork-tip FNB samples was 7.07 compared with 9.59 in the Franseen FNB samples (P < .001). The mean specimen length was 13.86 mm for the fork-tip FNB and 15.81 mm for the Franseen FNB (P = .004). Cores were intact in 47.6% of the fork-tip FNB samples and in 75.2% of the Franseen FNB samples (P = .004).


      In EUS-LB, we found that the 19-gauge Franseen FNB system resulted in a statistically significant increase in diagnostic adequacy compared with biopsy using the fork-tip FNB system.

      Graphical abstract


      CPTs (complete portal tracts), EUS-LB (endoscopic ultrasound-guided liver biopsy), FNB (fine-needle biopsy), SD (standard deviation)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Shulman A.
        • Thompson C.
        • Odze R.
        • et al.
        Optimizing EUS-guided liver biopsy sampling: comprehensive assessment of needle types and tissue acquisition techniques.
        Gastrointest Endosc. 2017; 85: 419-426
        • Eskandari A.
        • Koo P.
        • Bang H.
        • et al.
        Comparison of endoscopic ultrasound biopsy needles for endoscopic ultrasound-guided liver biopsy.
        Clin Endosc. 2019; 52: 347-352
        • Sey M.
        • Al-Haddad M.
        • Imperiale T.
        • et al.
        EUS-guided liver biopsy for parenchymal disease: a comparison of diagnostic yield between two core biopsy needles.
        Gastrointest Endosc. 2016; 83: 347-352
        • Diehl D.L.
        • Johal A.S.
        • Khara H.S.
        • et al.
        Endoscopic ultrasound-guided liver biopsy: a multicenter experience.
        Endosc Int Open. 2015; 3: E210-E215
        • Attam R.
        • Arain M.A.
        • Bloechl S.J.
        • et al.
        Wet suction technique (WEST): a novel way to enhance the quality of EUS-FNA aspirate. Results of a prospective, single-blind, randomized, controlled trial using a 22-gauge needle for EUS-FNA of solid lesions.
        Gastrointest Endosc. 2015; 81: 1401-1407
        • Shah A.
        • Al-Hanayneh M.
        • Chowdhry M.
        • et al.
        Endoscopic ultrasound guided liver biopsy for parenchymal liver disease.
        World J Hepatol. 2019; 11: 335-343
        • Stavropolulos S.N.
        • Im G.Y.
        • Jlayer Z.
        • et al.
        High yield of same-session EUS-guided liver biopsy by 19-gauge FNA needle in patients undergoing EUS to exclude biliary obstruction.
        Gastrointest Endosc. 2012; 75: 310-318
        • Parekh P.J.
        • Majithia R.M.
        • Diehl D.L.
        • et al.
        Endoscopic ultrasound-guided liver biopsy.
        Endosc Ultrasound. 2015; 4: 85-91
        • Mok S.R.S.
        • Diehl D.L.
        • Johal A.S.
        • et al.
        A prospective pilot comparison of wet and dry heparinized suction for EUS-guided liver biopsy (with videos).
        Gastrointest Endosc. 2018; 88: 919-925
        • Mok S.R.S.
        • Diehl D.L.
        The role of EUS in liver biopsy.
        Curr Gastroenterol Rep. 2019; 21: 6
        • Nieto J.
        • Khaleel H.
        • Challita Y.
        • et al.
        EUS-guided fine needle core liver biopsy sampling using a novel 19-guage needle with modified, 1-pass, 1 actuation wet suction technique.
        Gastrointest Endosc. 2018; 87: 469-475

      Linked Article