The Benign Liver EUS Optimal Core Study (BLOCs): A Prospective Randomized Multicenter Study Evaluating Wet-suction Versus Slow Pull Technique for EUS-guided Liver Biopsy.
Neil R Sharma, Harishankar Gopakumar, Harshit Khara et al.
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In 30 seconds
This prospective, randomized multicenter trial compared wet suction (WS) with slow stylet pull (SP) during endoscopic ultrasound-guided liver biopsy in patients undergoing parenchymal biopsy at six US centers. All procedures used a 19-gauge Franseen-tip needle. WS produced better histologic specimen yields: aggregate specimen length was 46.5 vs. 34.5 mm (P <0.001), and complete portal tract counts were 16 vs. 11.5 (P <0.001). Histologic diagnosis was achieved in 99% vs. 92%, while procedure length and adverse events were similar.
Key findings
- Aggregate specimen length was greater with WS than SP (46.5 vs. 34.5 mm, P <0.001).
- WS yielded more complete portal tracts than SP (16 vs. 11.5, P <0.001).
- Histologic diagnosis was achieved in 99% with WS and 92% with SP.
- Procedure length and adverse events did not differ between techniques.
Why it matters
Adequate tissue is important for histologic assessment of benign liver disease. In this randomized multicenter comparison, wet suction improved several measures of specimen yield and had a higher overall diagnostic rate, without a reported difference in procedure length or adverse events. These findings help clarify how suction technique may affect tissue obtained during EUS-guided liver biopsy.
What to keep in mind
The trial included patients at six tertiary US centers and evaluated a specific 19-gauge Franseen-tip needle and biopsy protocol; the findings may not apply to other settings or techniques.