Comparison of EUS-guided versus percutaneous and transjugular approaches for the performance of liver biopsies

Shuja, Asim; Alkhasawneh, Ahmad; Fialho, Andre; Fialho, Andrea; Shukri, Amal; Harris, Ciel; Smotherman, Carmen; Malespin, Miguel; Melo, Wanderley José de

doi:10.1016/j.dld.2019.01.006

Cited by 40 publications

(33 citation statements)

References 6 publications

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“…4,12 EUS-LB has been shown to have fewer complications than percutaneous or transjugular liver biopsies, while procuring a comparable amount of tissue acquisition. 14 In one comparative study, percutaneous and transjugular biopsies resulted in complications of pneumothorax, significant bleeding with hepatic artery pseudoaneurysm, and multiple cases of excruciating abdominal pain while EUS-LB had no adverse events. Diagnostic yields of percutaneous and transjugular liver biopsies are between 85%-99% and 80%-97% respectively.…”

Section: Discussionmentioning

confidence: 99%

Superior Specimen and Diagnostic Accuracy with Endoscopic Ultrasound-Guided Liver Biopsies Using 19-Gauge versus 22-Gauge Core Needles

et al. 2021

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Background/Aims: Endoscopic ultrasound-guided liver biopsy (EUS-LB) is an effective and safe method of procuring liver tissue. The aims of this study were to assess and compare the outcomes and tissue adequacy of a single-pass, single-actuation, wet suction technique between 19 G and 22 G needles in patients undergoing EUS-LB.Methods: We performed a prospective case series study of 20 patients undergoing EUS-LB at a single center between September 2017 and April 2020. The primary objective was to evaluate differences in sample adequacy via a single actuation wet suction technique between a 19 G core needle and a 22 G core needle. Adequacy was gauged by cumulative core biopsy length and the number of portal tracts visualized.Results: The 19 G needle provided a longer core length (2.5 cm vs. 1.2 cm, p<0.0001), more complete portal tracts (5.8 vs. 1.7, p<0.0001), more total tracts (8.8 vs. 3, p<0.0001), and a longer, intact, fragment length (0.75 cm vs. 0.32 cm, p<0.0006). The 19 G needle was superior in providing adequate (60% vs. 5%, p<0.001) and diagnostic pathologic samples (85% vs. 10%, p<0.001).Conclusions: A single-pass, single-actuation, wet suction technique using a 19 G needle is superior to that using a 22 G needle for tissue acquisition and sample adequacy in EUS-LB.

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Section: Discussionmentioning

confidence: 99%

Superior Specimen and Diagnostic Accuracy with Endoscopic Ultrasound-Guided Liver Biopsies Using 19-Gauge versus 22-Gauge Core Needles

et al. 2021

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“…The most prominent advantages of EUS-LB are that it relies on minor pain intensity as it does not include skin puncture, with image guidance thus ensuring blood vessel avoidance, providing access to all liver parenchyma including the entire left lobe and the majority of the right lobe. This allows quick and safe multiple liver passes from both lobes, thus decreasing histologic variability and providing same-session inspection of neighboring structures and lymph nodes and screening for varices [ 47 ]. As most US-guided, CT-guided, and transjugular liver biopsies are obtained from the right lobe, and as several studies reported variations in disease activity and staging in different liver lobes, a study by Khurana et al showed that EUS-guided bi-lobar liver biopsy improved disease activity and fibrosis assessments.…”

Section: Eus-guided Liver Biopsymentioning

confidence: 99%

A State-of-the-Art Review on the Evolving Utility of Endoscopic Ultrasound in Liver Diseases Diagnosis

et al. 2020

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Liver diseases are amongst the most common diseases worldwide and manifest as a parenchymatic and/or biliary injury due to several causes as well as focal liver lesions, ranging from benign to malignant ones. The diagnosis of liver diseases is based mainly on biochemical and advanced imaging studies and, when required, on liver biopsy. Endoscopic ultrasound (EUS), which combines endoscopy and ultrasonography, is one of the main examination techniques used in gastroenterology as it is applied to evaluate abnormalities in the lumen of the upper and lower gastrointestinal tract and to define pancreatic and hepato-biliary features, often in chronic patients. Given its high spatial resolution and its proximity to the liver, EUS is gaining popularity in the diagnostic work up of liver diseases. This is a comprehensive overview of the current literature on the diagnostic indications for EUS use in patients with liver diseases. We performed a MEDLINE\PubMed and Embase search, and all articles that were relevant, after reviewing abstracts, were assessed and the full text was analyzed to extract data regarding technical success, diagnostic yield, bioptic characteristics, and complications rate. EUS-guided imaging and biopsy techniques in liver diseases have shown consistent favorable promising results among the reports through the literature, with an excellent diagnostic yield and safety profile, especially in the context of focal lesions and portal hypertension. The application of EUS in the diagnosis of liver diseases is a promising technique and should be considered as a first-line therapeutic option in selected cases.

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“…Another study comparing EUS-LB with percutaneous and transjugular approaches reported that EUS-LB had less complications (P = 0.03) and increased specimen length (4.6 cm vs 3.6 cm, P < 0.01), while the complete portal tracts (CPTs) were lower in EUS-LB (10.8 vs 13.6, P < 0.01). 17 Looking at these results, EUS-LB seems acceptable to get an adequate liver specimen and can be considered a reasonable choice for LB. Bilobar sampling can reduce sampling error, [18][19][20] and this is much more easily accomplished with the EUS-LB than the percutaneous approach.…”

Section: Adequacy Of Specimen Comparing Traditional Liver Biopsymentioning

confidence: 93%

Endoscopic ultrasound guided hepatic interventions

Hashimoto

Chang

2020

Digestive Endoscopy

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Intervention for liver disease has predominantly been performed through the percutaneous approach. However, as endoscopic ultrasound (EUS) applications have expanded, there have emerged various EUS-guided interventions for liver disease, a space we call "Endo-Hepatology". EUS-guided liver biopsy can be considered the "forerunner" of Endo-Hepatology and has become a clinical option for patients requiring histologic diagnosis and staging of their liver disease. EUS also enables direct access to the portal vein. Subsequently, many procedures are being explored, such as angiography, measurement of the portosystemic pressure gradient, portal vein sampling to detect cancer cell or DNA, and EUS-guided transhepatic intrahepatic portosystemic shunt creation. Since the transducer is close to the liver, especially the left and caudate lobes, EUS can be used as a rescue when the percutaneous approach is not favorable and EUS-guided treatments of liver tumor, cyst and abscess have been reported. This review summarizes the available studies of EUS-guided intervention in the liver.

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Comparison of EUS-guided versus percutaneous and transjugular approaches for the performance of liver biopsies

Cited by 40 publications

References 6 publications

Superior Specimen and Diagnostic Accuracy with Endoscopic Ultrasound-Guided Liver Biopsies Using 19-Gauge versus 22-Gauge Core Needles

Superior Specimen and Diagnostic Accuracy with Endoscopic Ultrasound-Guided Liver Biopsies Using 19-Gauge versus 22-Gauge Core Needles

A State-of-the-Art Review on the Evolving Utility of Endoscopic Ultrasound in Liver Diseases Diagnosis

Endoscopic ultrasound guided hepatic interventions

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