Outcomes of EUS-guided liver biopsy using 22-gauge versus 19-gauge needles with a novel hydrostatic sampling technique.

Background And Aims: Prior data have shown that specimen quality deteriorates when 22-gauge needles are used in place of 19-gauge needles during EUS-guided liver biopsy (EUS-LB). Emerging data suggest that a novel hydrostatic sampling technique (HST) may offer improved performance over wet suction (WS). We hypothesized that EUS-LB using a 22-gauge fine-needle biopsy needle with the HST would attain tissue adequacy similar to that of 19-gauge needles.

Methods: We retrospectively examined a prospectively collected database of EUS-LBs between January 2021 and September 2024. All biopsies were performed with a 22- or 19-gauge needle using 1 pass with 3 actuations. All specimens were re-reviewed by an expert pathologist blinded to needle gauge and technique.

Results: A total of 126 EUS-LBs (30 via 22-gauge HST, 44 via 19-gauge HST, and 52 via 19-gauge WS) were performed in 120 patients. Compared with 22-gauge HST, tissue adequacy (length ≥2 cm and ≥11 complete portal tracts [CPTs]) was identical in 19-gauge HST (93% vs 93%; P = .98) and lower in 19-gauge WS (93% vs 85%; P = .25). Median aggregate specimen length was 5.10 cm, 5.63 cm, and 5.30 cm and CPT count was 24, 26, and 21 in 22-gauge HST, 19-gauge HST, and 19-gauge WS, respectively. The 22-gauge HST had significantly less blood contamination compared with both 19-gauge HST and 19-gauge WS with no significant differences in specimen fragmentation.

Conclusions: When using the HST, EUS-LB with 22-gauge needles meets adequacy standards at high rates similar to those of 19-gauge needles. The HST may allow for the use of 22-gauge needles in patients at high risk for adverse events or with challenging anatomies.