Background and Aims

As EUS-guided liver biopsy sampling (EUS-LB) becomes more widely used, further studies have investigated ways to improve tissue yields. Use of a heparin-primed needle may lead to less clotting of blood within the needle, improve tissue recovery, and decrease fragmentation. The purpose of this study was to prospectively evaluate wet suction using a heparin-primed needle for EUS-LB.

Methods

This was a prospective crossover study evaluating wet suction for EUS-LB in parenchymal liver disease. The primary outcome was specimen adequacy, defined by an aggregate specimen length ≥15 mm and ≥5 complete portal tracts (CPTs). Secondary outcomes included number of CPTs, length of the longest piece, aggregate specimen length, and number of small (≤4 mm), medium (5-8 mm), and large (≥9 mm) fragments. Adverse events were tracked at 7 and 30 days.

Results

One hundred twenty biopsy specimens were collected from 40 participants (3 specimens per patient). Specimen adequacy occurred in 39 wet heparin (98%), 37 dry heparin (93%), and 30 dry needle biopsy samples (80%; 95% confidence interval [CI], .14-.18; P = .01). There was no difference between dry needle techniques. Length of the longest piece was 8.9 mm for wet heparin and 5.8 mm for dry techniques (95% CI, .33-1.53; P = .003). Aggregate specimen length was 49.2 mm for wet heparin and 23.9 mm for dry heparin (95% CI, -46.34 to 44.94; P = .003). Mean CPT count was 7.0 for wet heparin versus 4.0 for dry (95% CI, .74-6.26; P = .01). There were more medium (2.0 vs 1.0; 95% CI, .06-1.24; P = .03) and large (1.0 versus 0.0; 95% CI, .33-1.53; P = .003) fragments with wet suction with no difference in small fragments between groups.

Conclusions

The use of wet suction EUS-LB demonstrated improved tissue adequacy compared with dry needle techniques. (Clinical trial registration number: NCT03103997.)

中文翻译：

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前瞻性比较湿法和干法肝素抽吸术对EUS指导的肝活检的作用（视频）

背景和目标

随着EUS指导的肝活检样本（EUS-LB）的使用越来越广泛，进一步的研究已经研究了提高组织产量的方法。使用肝素引发的针头可减少针头内的血液凝结，改善组织恢复并减少碎裂。这项研究的目的是前瞻性评估肝素灌注针用于EUS-LB的湿吸力。

方法

这是一项前瞻性交叉研究，评估湿吸对实质性肝病中EUS-LB的影响。主要结果是标本充分性，定义为标本总长度≥15mm和≥5个完整门脉（CPT）。次要结果包括CPT的数量，最长片的长度，标本的总长度以及小（≤4毫米），中（5-8毫米）和大（≥9毫米）碎片的数量。在第7天和第30天追踪不良事件。

结果

从40名参与者中收集了120个活检标本（每位患者3个标本）。39例湿肝素（98％），37例干肝素（93％）和30例干针穿刺活检样品（80％； 95％置信区间[CI] ，. 14-.18；P  = 0.01）发生了标本充分性。干针技术之间没有差异。对于湿肝素，最长片的长度为8.9毫米，对于干法技术，最长片的长度为5.8毫米（95％CI，.33-1.53​​；P  = .003）。湿肝素的标本总长度为49.2毫米，干肝素的标本总长度为23.9毫米（95％CI，-46.34至44.94；P  = 0.003）。湿肝素的平均CPT计数为7.0，而干肝素的平均CPT计数为4.0（95％CI，.74-6.26；P  = 0.01）。有更多的培养基（2.0 vs 1.0; 95％CI，.06-1.24; P = 0.03）和较大的 碎片（1.0比0.0; 95％CI，0.33-1.53​​; P = 0.003）具有湿吸力，组之间的小碎片没有差异。

结论

与干针技术相比，湿吸EUS-LB的使用显示出改善的组织适应性。（临床试验注册号：NCT03103997。）