Aims
EndoDrill® is a novel motorized biopsy tool for endoscopic ultrasound that is designed to collect high quality tissue cores with less blood contamination. This single use flexible biopsy device with a 17G rotating drill-tip cylinder is driven by a reusable electric motor unit, and the tip rotation is activated by pressing a foot pedal.
In this prospective matched-controlled study, we compared the diagnostic performance of the novel endodrill biopsy device and conventional 19G fine needle biopsy (FNB) needles for obtaining EUS-guided liver biopsies.
Methods
Consecutive eligible patients scheduled for untargeted EUS-guided liver biopsy were biopsied using the endodrill.
These patients were matched 1:2 for age and indications with patients undergoing untargeted EUS-LB using conventional 19 G EUS-FNB needles in wet-suction technique with one pass and 3-6 actuations. EUS-guided liver biopsies were performed by two experienced endoscopists.
Primary outcomes were the number of complete portal tracts (CPT) and aggregate specimen length. Secondary outcomes were user experience scores (0-10) for tissue penetration, visibility during biopsy, flexibility, handling and preparation of the biopsy device, and adverse events.
Results
Seven consecutive patients underwent EUS-guided liver biopsy with endodrill and 14 patients with 19G-FNB needles. Median age was 49 years with 57% male and 43% female patients. Aggregate sample length with endodrill and EUS-FNB was 14 mm± 7 mm vs. 40 mm ± 16 mm, respectively(p<0.001). Adequate samples defined as more than 10 CPT were obtained in 2/7 (29%) vs. 13/14 (93%; p<0.01) of cases with endodrill and 19G FNB, respectively. Number of CPT was 5 ± 4 vs. 16 ± 6 (p<0.003), respectively.
The drill device was rated highly in flexibility (8.9 ± 0.4) and easiness of preparation (9.8 ± 0.4). Visibility was hampered by artefacts due to the rotation (5.1 ± 2.8), and tissue penetration was scored low (2.9 ± 2.3).
There was one bleeding from the gastric wall requiring endoscopic clip application in the drill biopsy group.
Conclusions
For EUS-guided liver biopsies, the motorised biopsy device was not superior to the conventional 19G FNB needles regarding aggregate length of cores or count of portal tracts.