P1392 - Comparative Performance of Fork-Tip and Franseen Fine-Needle Biopsy Systems in Endoscopic Ultrasound-Guided Liver Biopsy: A Systematic Review and Meta-Analysis

Rami Musallam, MD¹, Abbinaya Elangovan, MD¹, Jay Bapaye, MD¹, Subhash Garikipati, MD¹, Faris Shweikeh, MD², Anas Kartomah, MS³, Mohannad Abousaleh, MD⁴, Babu P. Mohan, MD⁵, Paul Yeaton, MD⁶, Patrick Okolo, MD⁶, Marrieth Rubio, MD⁶, Klaus Monkemuller, MD⁶, Varun Kesar, MD⁷, Vivek Kesar, MD⁶
1Carilion Clinic, Roanoke, VA; 2Harbor-UCLA Medical Center, Torrance, CA; 3USF, Tampa, FL; 4Huron Gastro Ann Arbor, Ypsilanti, MI; 5Orlando Gastroenterology PA, Orlando, FL; 6CARILION CLINIC, Roanoke, VA; 7Virginia Tech Carilion School of Medicine, Roanoke, VA

Introduction: Procedural standardization in endoscopic ultrasound-guided liver biopsy (EUS-LB) is crucial for obtaining core biopsy specimens that ensure accurate diagnosis. We conducted a systematic review and meta-analysis to compare the diagnostic performance and safety of the Fork-tip and Franseen fine-needle biopsy (FNB) systems in EUS-LB, focusing on diagnostic yield, specimen quality, and adverse events.

Methods: A comprehensive search of multiple electronic databases, including PubMed, EMBASE, and Web of Science (from inception to October 2024), was performed to identify studies reporting on EUS-guided liver biopsy using these two FNB systems. The primary outcomes included pooled rates of successful diagnosis, number of complete portal tracts (CPTs), total specimen length (TSL), and longest specimen length (LSL). The secondary outcome was to estimate the pooled adverse event rates associated with each FNB system. Standard meta-analysis methods were employed using a random-effects model, and heterogeneity was assessed using the I2 index.

Results: A total of 34 studies involving 1,815 patients were included. The Fork-tip FNB (SharkCore, Medtronic Corporation, Minneapolis, Minn, USA) was evaluated in 12 study arms, the Franseen FNB (Acquire, Boston Scientific Corporation, Marlborough, Mass, USA) in 33 arms. Our analysis demonstrated the highest diagnostic success rate with the Franseen FNB 19G (96.5%), marginally outperforming the Fork-tip FNB 19G (94.5%). The pooled mean number of complete portal triads (CPTs) was higher for the Franseen FNB 19G (18.33) compared to the Fork-tip FNB 19G (15.7), while the Fork-tip FNB 19G achieved a slightly greater pooled mean total specimen length (TSL) at 51.41 mm versus 47.26 mm for the Franseen FNB 19G. Biopsies targeting both hepatic lobes enhanced diagnostic success rates, CPTs, and TSLs for both needle systems, with the Franseen FNB 19G demonstrating superior diagnostic outcomes. Smaller 22G needles exhibited reduced performance in CPTs, TSL, and diagnostic adequacy, with the Franseen 22G showing the lowest diagnostic success rate (84.8%) (Table 1). Adverse events were rare across all groups, though the Franseen FNB was associated with the highest overall adverse event rate (6.7%) (Table 2). No significant publication bias was identified.

Discussion: In EUS-LB, the 19-gauge Franseen FNB system, with biopsies obtained from both lobes, demonstrated superior diagnostic adequacy compared to other FNB systems.


Figure:
Table 1: Pooled Rates Analysis by Gauge for Fork-tip and Franseen FNB Systems


Figure:
Table 2: Summary of Pooled Adverse Event Rates for FNB Systems

Disclosures:
Rami Musallam indicated no relevant financial relationships.
Abbinaya Elangovan indicated no relevant financial relationships.
Jay Bapaye indicated no relevant financial relationships.
Subhash Garikipati indicated no relevant financial relationships.
Faris Shweikeh indicated no relevant financial relationships.
Anas Kartomah indicated no relevant financial relationships.
Mohannad Abousaleh indicated no relevant financial relationships.
Babu Mohan indicated no relevant financial relationships.
Paul Yeaton indicated no relevant financial relationships.
Patrick Okolo indicated no relevant financial relationships.
Marrieth Rubio indicated no relevant financial relationships.
Klaus Monkemuller indicated no relevant financial relationships.
Varun Kesar indicated no relevant financial relationships.
Vivek Kesar indicated no relevant financial relationships.

Rami Musallam, MD¹, Abbinaya Elangovan, MD¹, Jay Bapaye, MD¹, Subhash Garikipati, MD¹, Faris Shweikeh, MD², Anas Kartomah, MS³, Mohannad Abousaleh, MD⁴, Babu P. Mohan, MD⁵, Paul Yeaton, MD⁶, Patrick Okolo, MD⁶, Marrieth Rubio, MD⁶, Klaus Monkemuller, MD⁶, Varun Kesar, MD⁷, Vivek Kesar, MD⁶. P1392 - Comparative Performance of Fork-Tip and Franseen Fine-Needle Biopsy Systems in Endoscopic Ultrasound-Guided Liver Biopsy: A Systematic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.