Dang Frances, Cheung David, Yu Michael Andrew, Rahim Usman, Kwon Joshua, Tavangar Amirali, Samarasena Jason, Chang Kenneth
Division of Gastroenterology/Hepatology, University of California Irvine School of Medicine, Orange, California, USA.
Department of Internal Medicine, University of California Irvine School of Medicine, Orange, California, USA.
VideoGIE. 2025 Mar 1;10(7):364-367. doi: 10.1016/j.vgie.2025.02.013. eCollection 2025 Jul.
EUS-guided liver biopsy (EUS-LB) has emerged as a reliable alternative to interventional radiology-guided biopsy, offering comparable specimen adequacy. Bleeding remains the most common adverse event. We describe a novel use of absorbable gelatin sponge slurry for hemostasis during EUS-LB and propose a stepwise management approach.
Liver biopsy was performed using a dynamic suction technique with a 19-gauge fine-needle biopsy needle. After biopsy, e-Flow Doppler was used to evaluate for bleeding. Since Doppler flow persisted, initial management included leaving the needle in place for 4 minutes and performing a blood patch technique. For bleeding extending beyond the liver capsule, a gelatin sponge slurry was prepared by macerating absorbable gelatin pledgets into a thick gel using the Tessari technique. The slurry was injected into the bleeding tract while withdrawing the needle under EUS guidance.
Application of this stepwise approach during EUS-LB successfully achieved hemostasis without the need for surgical or radiologic intervention. The gelatin sponge slurry effectively sealed the bleeding tract, with no significant postprocedural hematoma or ongoing hemorrhage observed.
The use of an absorbable gelatin sponge slurry represents a promising salvage technique for managing bleeding during EUS-LB when conventional methods fail.
超声内镜引导下肝活检（EUS-LB）已成为介入放射学引导下活检的可靠替代方法，所取标本的充足率相当。出血仍是最常见的不良事件。我们描述了一种可吸收明胶海绵浆液在EUS-LB术中止血的新用途，并提出了一种分步处理方法。
采用动态抽吸技术，使用19号细针活检针进行肝活检。活检后，使用e-Flow多普勒评估是否出血。由于多普勒血流持续存在，初始处理措施包括将针留在原位4分钟并实施血液补片技术。对于超出肝包膜的出血，采用Tessari技术将可吸收明胶小块浸软制成浓稠凝胶，制备明胶海绵浆液。在超声内镜引导下退针时，将该浆液注入出血通道。
在EUS-LB术中应用这种分步方法成功实现了止血，无需手术或放射学干预。明胶海绵浆液有效封闭了出血通道，未观察到明显的术后血肿或持续出血。
当传统方法无效时，使用可吸收明胶海绵浆液是处理EUS-LB术中出血的一种有前景的挽救技术。
