Endoscopic ultrasound-guided liver biopsy (EUGLB) has become an alternative to percutaneous biopsy. The most commonly used techniques require several punctures in both hepatic lobes. The technique with dynamic aspiration with heparin (DAH) allows the procedure to be performed with a single puncture without affecting quality indicators. Our aim is to describe our center's experience with the implementation of EUGLB with DAH.

Retrospective study of patients undergoing EUGLB with DAH from September 2024 to June 2025 at our center. Clinical, anatomicopathological, and procedural data were collected. The procedure was performed using the DAH technique with a single transduodenal puncture with a 19F biopsy needle (Boston Adquire) on the right hepatic lobe. An adequate sample was defined as ≥ 20 mm in size and including ≥ 11 complete portal spaces (CPS).

A total of 30 EUGLB procedures were performed with DAH. The main indication was hypertransaminasemia (81.7%). Other indications were suspected rejection (4.5%) and acute hepatitis (13.7%). The mean total sample size was 58.7 ± 26.6 mm, the mean size of the largest fragment was 20.6 ± 9.22 mm, and the mean number of CPS was 12 ± 6.79. An adequate sample was obtained in 68.7% of cases, and a histological diagnosis was possible in 100% of cases. No serious adverse effects were observed, and all patients were discharged in less than 12 hours. In 2 cases (6.6%), abdominal pain was reported, which was controlled with first-line analgesia.

EUGLB with DAH has proven to be a safe and effective technique for obtaining liver parenchyma samples with a single puncture.