19G FNB Vs 19G FNA-EUS guided liver biopsy- A non-inferiority randomized controlled trial

Chronic liver disease can be due to various causes and usually diagnosed based on identification of risk factors and various blood tests. Identification of etiology becomes important as modification of risk factors and treatment of underlying cause of CLD can results in prevention of further liver damage and also reversal of underlying fibrosis or cirrhosis.  There are various methods of liver biopsy with each modality has its merits and demerits. Previous studies have demonstrated that percutaneous, trans jugular and EUS guided liver biopsy were comparable in sample adequacy, but however, EUS liver biopsy was associated with lesser adverse events.In EUS guided liver biopsy previous studies have demonstrate that FNB needle gives larger samples than FNB but however, the histological diagnosis was comparable in both the groups. But, FNB needle costs around INR 40000 with one unit kit pricing around INR 63000 while FNA needle costs around 20000 with one EUS kit costing around 36000 making it more cost effective . In view of limited data comparing EUS LB using 19 G FNA versus 19 G FNB needles, we have planned this non inferiority randomized controlled trial comparing FNA vs FNB with 19 G needle taking primary objective as pre processing total sample length of atleast 15 mm and portal tracts of atleast 5 in number and histological diagnosis taking previously done studies as references.