“Wet Heparin” and “Wet Saline” EUS-Guided Liver Biopsy Techniques Both Provide High Rates of Specimen Adequacy for Benign Parenchymal Liver Disease

Saraireh, Hamzeh; Abdelfattah, Thaer; Hassouneh, Ramzi; Lippman, Robert; Puri, Puneet; Mutha, Pritesh; Singh, Simran; Fuchs, Michael; Shah, Tilak

doi:10.1007/s10620-022-07399-7

Cited by 4 publications

(3 citation statements)

References 13 publications

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“…Likewise, the limited number of RCTs did not enable us to perform further sensitivity analyses based on specific technical strategy for tissue sampling, such as number of actuations during needle passes or use of wet-suction biopsy. Preliminary studies [ 30 , 31 ] gave some indications in this regard but evidence is still too scarce to reach an agreement on the best tissue sampling technique for EUS-LB, as we have for pancreatic masses [ 7 ]. On the other hand, no different results were observed based on the different needle size used during PC-LB, whether 16 G or 18 G.…”

Section: Discussionmentioning

confidence: 97%

Diagnostic Yield of Endoscopic Ultrasound-Guided Liver Biopsy in Comparison to Percutaneous Liver Biopsy: A Meta-Analysis of Randomized Controlled Trials and Trial Sequential Analysis

Bhandari,

Samanta,

Spadaccini

et al. 2024

Diagnostics

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Background: The efficacy of endoscopic ultrasound-guided liver biopsy (EUS-LB) compared to percutaneous liver biopsy (PC-LB) remains uncertain. Methods: Our data consist of randomized controlled trials (RCTs) comparing EUS-LB to PC-LB, found through a literature search via PubMed/Medline and Embase. The primary outcome was sample adequacy, whereas secondary outcomes were longest and total lengths of tissue specimens, diagnostic accuracy, and number of complete portal tracts (CPTs). Results: Sample adequacy did not significantly differ between EUS-LB and PC-LB (risk ratio [RR] 1.18; 95% confidence interval [CI] 0.58–2.38; p = 0.65), with very low evidence quality and inadequate sample size as per trial sequential analysis (TSA). The two techniques were equivalent with respect to diagnostic accuracy (RR: 1; CI: 0.95–1.05; p = 0.88), mean number of complete portal tracts (mean difference: 2.29, −4.08 to 8.66; p = 0.48), and total specimen length (mean difference: −0.51, −20.92 to 19.9; p = 0.96). The mean maximum specimen length was significantly longer in the PC-LB group (mean difference: −3.11, −5.51 to −0.71; p = 0.01), and TSA showed that the required information size was reached. Conclusion: EUS-LB and PC-LB are comparable in terms of diagnostic performance although PC-LB provides longer non-fragmented specimens.

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Section: Discussionmentioning

confidence: 97%

Diagnostic Yield of Endoscopic Ultrasound-Guided Liver Biopsy in Comparison to Percutaneous Liver Biopsy: A Meta-Analysis of Randomized Controlled Trials and Trial Sequential Analysis

Bhandari,

Samanta,

Spadaccini

et al. 2024

Diagnostics

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“…Heparin ( 16 ) has previously been used in percutaneous liver puncture to increase the specimen yield by reducing blood coagulation during the puncture process. Subsequent studies ( 8 , 12 ) have adopted heparin for EUS-guided fine-needle liver biopsy and discovered that heparin prevented the adhesion of tissue strips to the needle tubing wall because of blood coagulation, thus increasing the amount of obtained specimen.…”

Section: Discussionmentioning

confidence: 99%

Detection value of endoscopic ultrasound-guided 19G fine-needle wet-heparinized suction for pancreatic solid tumors: a randomized controlled trial

Xu¹,

Lü²,

Xu³

et al. 2023

Gland Surg

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Background: Conventional endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has some inevitable flaws in the detection of pancreatic solid tumors, such as an incomplete histological structure of the obtained pancreatic biopsy tissues and blood coagulation. Heparin can prevent blood coagulation, thus improving the structural integrity of the specimen. However, whether the combination of EUS-FNA and wet heparin can improve the detection of pancreatic solid tumors needs to be further explored. Hence, this study aimed to compare the EUS-FNA combined with wet heparin and the conventional EUS-FNA, and analyze the detection value of EUS-FNA combined with wet heparin for pancreatic solid tumors. Methods:The clinical data of 52 patients with pancreatic solid tumors who had received EUS-FNA at the Wuhan Fourth Hospital from August 2019 to April 2021 were selected. Patients were divided into a heparin group and a conventional wet-suction group using a randomized number table. The total length of biopsy tissue strips, total length of white tissue core in pancreatic biopsy lesions [according to macroscopic onsite evaluation (MOSE)], total length of white tissue core in each biopsy tissue, erythrocyte contamination in the paraffin sections, and postoperative complications were compared between the groups. The receiver operating characteristic curve was used to reflect the detection value of EUS-FNA combined with wet heparin for pancreatic solid tumors. Results:The heparin group had a longer total length of biopsy tissue strips (P<0.05) and total length of white tissue core (P<0.05) than the conventional group. There was a positive correlation between the total length of white tissue core and the total length of biopsy tissue strips in both groups (conventional wetsuction group: r=0.470, P<0.05; heparin group: r=0.433, P<0.05). The heparin group had milder erythrocyte contamination in the paraffin sections (P<0.05). The total length of white tissue core in the heparin group had the highest diagnostic performance, with a Youden index of 0.819 [area under the curve (AUC) =0.944].Conclusions: Our research shows that wet-heparinized suction improves the quality of pancreatic solid tumor tissue biopsy obtained by 19G fine-needle aspiration and is a safe and efficient aspiration method in conjunction with MOSE for tissue biopsy.

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“…A 2022 study further compared the performance between EUS-LB wet suction with heparin versus saline techniques. [ 48 ] The preliminary results showed that the specimen adequacy was similar between those 2 groups, which was indicative of comparable aggregate specimen length (heparin: 43 mm, saline: 40 mm; P = 0.16) and longest piece length (heparin: 10 mm, saline: 8 mm; P = 0.19). As expected, wet heparin EUS-LB gave rise to fewer frequencies of clots as compared with its opponent using wet saline (18% vs .…”

Section: Introductionmentioning

confidence: 88%

Distinct ways to perform a liver biopsy: The core technique setups and updated understanding of these modalities

Sun,

Zhao,

Shi

et al. 2023

Endosc Ultrasound

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There is dramatically increased incidence of several liver diseases worldwide; thus, an unmet need to diagnose and stage these pathological entities heralds the wide application of liver biopsy (LB) techniques. The ways of LB are versatile, including percutaneous LB, transjugular LB, and more recently an approach of minimal invasiveness, that is, EUS-guided LB (EUS-LB). In this review article, we come to the conclusion that EUS-LB may serve as a feasible, reliable, and safe alternative to percutaneous LB and transjugular LB in terms of improved diagnostic yield, excellent sampling performance, and controlled adverse events among patients with focal, infiltrative, and parenchymal liver diseases. Furthermore, extensive efforts have been made to optimize and refine several technical pillars within EUS-LB modality such as the selection of needle size/type, priming manner of biopsy needle, and choice of pass/actuation technique, all of which aim at obtaining better specimen quantity and quality. Another advantageous aspect and unique property pertinent to EUS-guided modality indicate that multiple screening, surveillance, and intervention procedures can be combined into one single endoscopic session. Accordingly, some pilot studies have clarified the clinical usefulness by integrating EUS-LB with simultaneous measurement of portal pressure gradient or examination of liver stiffness. However, more studies, in particular, randomized controlled trials or real-world evidence, are practically warranted to elucidate the validity and safety of EUS-LB as a regular/routine part of managing liver diseases.

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“Wet Heparin” and “Wet Saline” EUS-Guided Liver Biopsy Techniques Both Provide High Rates of Specimen Adequacy for Benign Parenchymal Liver Disease

Cited by 4 publications

References 13 publications

Diagnostic Yield of Endoscopic Ultrasound-Guided Liver Biopsy in Comparison to Percutaneous Liver Biopsy: A Meta-Analysis of Randomized Controlled Trials and Trial Sequential Analysis

Diagnostic Yield of Endoscopic Ultrasound-Guided Liver Biopsy in Comparison to Percutaneous Liver Biopsy: A Meta-Analysis of Randomized Controlled Trials and Trial Sequential Analysis

Detection value of endoscopic ultrasound-guided 19G fine-needle wet-heparinized suction for pancreatic solid tumors: a randomized controlled trial

Distinct ways to perform a liver biopsy: The core technique setups and updated understanding of these modalities

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