Liver biopsy is important for diagnosing liver disease. Adequacy of biopsy specimen is essential for accurate pathology evaluation. The American Association for the Study of Liver Disease (AASLD) defines an adequate sample containing more than eleven complete portal tracts (CPT) and measuring at least 1.5 cm in length. EUS-guided liver biopsy (EUS-LB) has emerged as a promising alternative to traditional percutaneous or transjugular liver biopsy. Prior studies have shown that variation in liver biopsy technique impacts tissue yield, and studies evaluating various techniques have been performed. The dynamic suction technique is a simple modification of the wet heparin suction technique that obtains exceedingly adequate liver biopsy specimens for diagnosis. The aim of this study is to evaluate the safety, efficacy, and tissue adequacy of EUS-LB with the dynamic suction technique. 

This is a retrospective study including all patients that underwent EUS-LB with the dynamic suction technique at our institution in 2025. Clinical, laboratory, and procedural data were collected. All biopsies were performed with 1 pass, 3 actuations using a 19 G EUS-FNB needle primed with 3 mL of heparinized saline. The primary endpoint was technical success rate and diagnostic adequacy as per pathologist. Secondary endpoints include total specimen length, number of complete portal tracts, stage of fibrosis, and rate of adverse events. 

A total of 23 patients were identified to have undergone EUS-LB with dynamic suction technique from January to November 2025. The average age was 61, with 48% female. The mean INR was 1.08 (0.9-1.2) and the mean platelet count was 164.5 (x10^3/mm3) (56-334). Unilobar biopsy was performed in all cases (87% in right lobe and 13% left lobe). Indications for liver biopsy included chronic liver disease (57%), evaluation of abnormal LFTs (43%), and stratification of portal hypertension (17%). The technical success rate of EUS-LB was 100% with diagnostic adequacy by pathology achieved in all cases. The average fixed liver specimen length per pathology was 6 cm (SD 1.5) and average CPT 14 (SD 6.2). 22% of specimens were staged as fibrosis stages F1-F2, while 39% were staged as F3-F4. There were no adverse events or procedure complications reported.  

The dynamic suction method is an effective adaptation of the wet suction method during EUS-LB. We achieved consistently adequate tissue acquisition with 1 pass, 3 actuations with no adverse events. Our findings support the dynamic suction method as a safe, reliable, and practical approach for obtaining diagnostic liver tissue.