Wu Ying, Xie Ni, Su Guanhao, Qu Ying, Ni Jianbo, Peng Kui, Song Yiran, Wen Wen, Li Baiwen
Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China.
Shanghai Key Laboratory of Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China.
Gastroenterol Rep (Oxf). 2025 Jul 3;13:goaf062. doi: 10.1093/gastro/goaf062. eCollection 2025.
Endoscopic ultrasound (EUS)-guided liver biopsy has been an effective method for acquiring liver tissue. However, currently, there is no consensus on the technical details of biopsy sampling. This study aimed to optimize the EUS-guided liver biopsy techniques to improve specimen quality.
EUS-guided liver biopsies were performed in four porcine subjects with four technical aspects: negative pressure suction, number of actuations, two puncture manipulations, and two types of puncture needles. The primary outcomes were total specimen length (TSL) and complete portal tracts (CPTs), the secondary outcomes included longest specimen length (LSL), number of specimen pieces, specimen fragmentation, blood contamination, and bleeding.
Forty-four biopsy samplings were performed. In Phase I, specimens obtained with 1-mL suction demonstrated significantly superior TSL, CPTs, and LSL compared with other suction techniques according to multiple comparisons. In Phase II, median TSL and CPTs with fewer than three actuations were significantly higher compared with those with at least three actuations (<0.05). In Phase III, the modified "click-puncture" yielded superior median CPTs, TSL, and LSL in comparison with conventional puncture (<0.05). In Phase IV, a fine-needle aspiration (FNA) needle was effective with a low risk of bleeding and foreign-tissue embedding (<0.05).
Optimal techniques for specimen quality in EUS-guided liver biopsy include using 1-mL suction, no more than three actuations, and employing a modified "click-puncture" manipulation. While FNA and fine-needle biopsy needles achieved comparable specimen quality, the FNA needle demonstrated the prevention of bleeding and foreign-tissue embedding.
内镜超声（EUS）引导下肝活检一直是获取肝组织的有效方法。然而，目前对于活检采样的技术细节尚无共识。本研究旨在优化EUS引导下肝活检技术以提高标本质量。
对4头猪进行EUS引导下肝活检，涉及四个技术方面：负压吸引、穿刺次数、两种穿刺操作以及两种穿刺针类型。主要结局指标为标本总长度（TSL）和完整门静脉分支（CPT），次要结局指标包括最长标本长度（LSL）、标本块数、标本破碎情况、血液污染及出血情况。
共进行了44次活检采样。在第一阶段，根据多重比较，与其他吸引技术相比，采用1 mL负压吸引获取的标本在TSL、CPT和LSL方面表现显著更优。在第二阶段，穿刺次数少于3次的中位TSL和CPT显著高于至少穿刺3次的情况（<0.05）。在第三阶段，改良的“点击穿刺”与传统穿刺相比，中位CPT、TSL和LSL更优（<0.05）。在第四阶段，细针抽吸（FNA）针有效，出血和异物组织嵌入风险较低（<0.05）。
EUS引导下肝活检中提高标本质量的最佳技术包括使用1 mL负压吸引、穿刺次数不超过3次以及采用改良的“点击穿刺”操作。虽然FNA针和细针活检针获得的标本质量相当，但FNA针可预防出血和异物组织嵌入。
