Comparison of diagnostic outcomes, safety, and cost of Franseen-tip 19G versus 22G Needles for Endoscopic Ultrasound-Guided Liver Biopsies

Background and Objective: Favourable outcomes were noted with refinement in newer EUS-Guided Liver biopsy (EUS-LB) needle tips. Still, the overall usefulness and benefit are yet to be well explored. Methods: This is a retrospective analysis of patients with EUS-LB (Franseen-tip 19G versus 22G FNB needle) over two years. EUS-LB was obtained in a one-pass, two-actuation, modified wet suction technique. Diagnostic yield, fragmentation rate, aggregate specimen length (AL), number of complete portal tracts (CPT), length of longest intact core (LIC), adverse events (early), and cost of the procedure (1USD = 82 ₹) were compared. Results: Fifty-four patients [33(61.1%), female] successfully underwent EUS-LB with a median age of 46 years (IQR 34-54); the majority underwent 32(59.2%) 19G biopsies. There was a significantly increased median (IQR) AL in the 19G compared to 22G [20(19-21) vs. 15(14-15) mm, P < 0.001], respectively. Similarly, significantly lengthier median LIC and CPT were seen, respectively. A nonsignificant diagnostic yield was noted [100% vs. 90.9%, P = 0.082], respectively. The fragmentation rate was higher in 22G FNB needles (36.4% [95% CI 16-56] vs. 12.5% [95% CI 1-24], respectively; P = 0.038). Seven (12.9%) patients had mild adverse events with no difference between groups. The average procedural cost with 19G was ₹63000 (768$), and with 22G needle was ₹54500 (664$). Conclusions: The franseen-tip 19G outperforms 22G with a significantly lower fragmentation rate, longer AL, LIC, and a higher number of CPT with a marginal increase in the procedure cost, without any difference in diagnostic yield and safety.