Endoscopic ultrasound-guided liver biopsy: a multicenter experience

Abstract

Background and aims: Endoscopic ultrasound-guided (EUS) liver biopsy (LB) is proposed as a newer method that offers several advantages over existing techniques for sampling liver tissue. This study evaluated the diagnostic yield of EUS-LB as the primary outcome measure. In addition, the safety of the technique in a large patient cohort was assessed. Patients and methods: Patients undergoing EUS for evaluation of elevated liver enzymes or hepatic disease were included in this prospective, non-randomized, multicenter study. EUS-LB was performed with EUS-fine needle aspiration (FNA; 19-gauge needle). Tissue was formalin-fixed and stained with hematoxylin and eosin, and trichrome. Using a microscope micrometer, specimen length was measured and the number of complete portal triads (CPTs) were counted. The main outcome measure was to assess the diagnostic yield of EUS-LB, and to monitor for any procedure-related complications. Results: Patients (110; median age, 53 years; 62 women) underwent EUS-LB at eight centers. The indication was abnormal liver enzymes in 96 patients. LB specimens sufficient for pathological diagnosis were obtained in 108 of 110 patients (98 %). The overall tissue yield from 110 patients was a median aggregate length of 38 mm (range, 0 – 203), with median of 14 CPTs (range, 0 – 68). There was no statistical difference in the yield between bilobar, left lobe only, or right lobe only biopsies. There was one complication (0.9 %) where self-limited bleeding occurred in a coagulopathic and thrombocytopenic patient. This complication was managed conservatively. Conclusions: EUS-guided LB was a safe technique that yields tissue adequate for diagnosis among 98 % of patients evaluated.

EUS-guided liver biopsy provides diagnostic samples comparable with those via the percutaneous or transjugular route

“…The diagnostic yield was 100%. Our group described a similar positive experience of EUS-LB in a multicenter trial5 . In this report, total mean specimen length was 38 mm, and mean CPT count of 14.…”

“…One hundred and ten patients had EUS-LB done as part of a multicenter study conducted from November 2011 to September 2013 5 . The inclusion criteria were as follows: age 18 M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 4 years or older, presence of abnormal liver function tests of undetermined etiology with possible biliary obstruction, or those patients already undergoing upper endoscopy who would also benefit from a liver biopsy, as determined by the referring hepatologist (eg, abnormal liver function tests (LFT) or fatty liver disease on imaging).…”

“…There are emerging data that sampling error may play an important role in staging of NASH 9 , so EUS-LB may be able to decrease histological variability by sampling widely different areas of the liver. Available medical literature4,5,8 confirms that adequate specimens and tissue diagnosis can be obtained with a regular 19-g EUS-FNA needle via the EUS-LB technique.Performing EUS-LB along with an EGD when there are concomitant indications for both can make the combination cost-effective. It is clinically reasonable and feasible to perform EUS-LB in the same endoscopic session in patients with elevated liver function test endoscopic evaluation of the biliary tree if no biliary obstruction is found.…”

“…There is emerging evidence of the usefulness of EUS-guided liver biopsy (EUS-LB) in providing a tissue sample adequate for histological interpretation by a pathologist 4,5 . A head-to-head comparison of histologic yield of EUS-LB to other methods of LB has not been done.…”

Endoscopic ultrasound-guided liver biopsy in pediatric patients

“…[123] A recent novel application in adults is EUS-guided liver biopsy (EUS-LB) which has proven to be technically safe, and provides adequate tissue yields for evaluation of liver disease;[4567] but the use of EUS-LB has never been reported in the pediatric population. We report the first case series of EUS-LB performed in the pediatric population.…”