Endoscopic ultrasound in chronic liver disease

Table 1 Comparison of needle performance in endoscopic ultrasound-guided liver biopsies

Ref.	Design	Exclusion criteria	Needle	Median (range) number of complete portal tracts	Median (range) aggregate specimen length, mm	Median (range) number of passes	Adequacy (%)	Complications (number of patients)
Human studies
Stavropoulos et al[20], 2012	Prospective (n = 22 patients)	Suspected/ known malignancy; Platelet < 50, INR > 1.5; Use of antiplatelets within 7 days; Inability to provide informed consent; Pregnancy	19-G EchoTip® FNA (Cook Medical)	9 (1-73)	36.9 (2-184.6)	2 (1-3)	91%	None
Diehl et al[21], 2015	Prospective, non-randomized (n = 110 patients)	Malignant liver disease; Platelet < 50, INR > 1.5; Use of antiplatelets within 5 days; Inability to provide consent; Pregnancy	19-G Expect™ FNA (Boston Scientific) or 19-G Expect™ Flexible FNA (Boston Scientific)	14 (0-68)	38 (0-203)	1 or 2	98%	Pericapsular hematoma (1)
Sey et al[82], 2015	Cross-sectional (n = 75 patients)	Liver lesion or presence of varices Prior upper GI or liver surgery; Use of antiplatelets not held prior to procedure; Platelet < 50, INR > 1.5	19-G EchoTip® ProCore FNB (Cook Medical) (n = 30)	5 (0-24)	20 (5-60)	2 (1-3)	97%	None
			19-G Quick-Core® FNB (Cook Medical) (n = 45)	2 (0-15)	9 (0-25)	3 (1-7)	73%	Abdominal pain (2)
Shah et al[83], 2017	Retrospective (n = 24 patients)	Not stated	19-G SharkCore™ FNB (Medtronic)	31.5 (5-85)	65.6 (17-167.4)	2	87.5%	Abdominal Pain (2); Subcapsular bleeding (1)
Mok et al[23], 2018	Randomized cross-over (n = 80 patients)	Platelets < 50, INR > 1.5; Diagnosis of cirrhosis ; Under 18 years age; Inability to provide informed consent; Pregnancy	19-G Expect™ Flexible FNA (Boston Scientific)	7.413	76.513	1	88%	None
			22-G SharkCore™ FNB (Medtronic)	6.1913	66.91,3	1	68%	Abdominal Pain (1)
Cadaveric studies
Lee et al[84], 2017	Nonrandomized (n = 2 livers)	N/A	19-G EchoTip® ProCore FNB (Cook Medical)	3.331	4732			N/A
			19-G EZ Shot 2 FNA (Olympus Corporation)	4.001	2982
			19-G Expect™ Slimline FNA (Boston Scientific)	4.421	4262
			19-G SharkCore™ FNB (Medtronic)	8.831	5072
			18-G TruCore™ (Argon Medical Devices)	7.001	1552
Schulman et al[25], 2017	Randomized (n = 2 livers)	N/A	19-G SharkCore™ FNB (Medtronic)	6.21			85.4%	N/A
			22-G SharkCore™ FNB (Medtronic)	3.81			85.4%
			19-G EchoTip® ProCore FNB (Cook Medical)	1.71			About 19%
			19-G Expect™ FNA (Boston Scientific)	1.91			About 46%
			18-G Quick-Core® FNB (Cook Medical)	2.51			83.3%
			18-G Coaxial Temno® (CareFusion)	3.51			81.3%
Bovine studies
Eskandari et al[24], 2019	Nonrandomized (n = 1 bovine liver)	N/A	19-G Acquire™ FNB (Boston Scientific)	11.81	71.301	5		N/A
			22-G Acquire™ FNB (Boston Scientific)	6.41	44.941	5
			19-G SharkCore™ FNB (Medtronic)	10.41	51.501	5
			22-G SharkCore™ FNB (Medtronic)	1.41	20.891	5
			19-G EZ Shot 3 Plus FNA (Olympus Corporation)	10.21	71.771	5
			20-G EchoTip® ProCore FNB (Cook Medical)	7.21	79.791	5

¹Mean.

²Total specimen length.

³Results not statistically significant. INR: International normalized ratio; G: Gauge; FNA: Fine needle aspiration; FNB: Fine needle biopsy; N/A: Not applicable.

Table 2 Most frequent adverse events associated with endoscopic ultrasound-guided liver biopsy

Adverse event	Event frequency/number of patients in the study
Abdominal pain or nausea	7/499[9,85]
Fever	2/167[85]
Bleeding	1/167[85]
Duodenal perforation	2/332[9]
Death	1/167[85]