The Role of EUS in Liver Biopsy

Mok, Shaffer; Diehl, David L.

doi:10.1007/s11894-019-0675-8

Cited by 20 publications

(25 citation statements)

References 32 publications

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“…Unlike with PC liver biopsy, the fact that patients undergoing EUS are usually sedated eliminates problems with patient cooperation, which would otherwise raise the risk of bleeding. The 1 hour proved to be sufficient to achieve pain relief according to the meta-analysis by Mohan et al [17]. In the 437 patients who underwent EUS-MLB included in the meta-analysis, the pooled rate of AEs with EUSguided LB was 2.3 %.…”

Section: Discussionmentioning

confidence: 92%

EUS-guided fine-needle core liver biopsy with a modified one-pass, one-actuation wet suction technique comparing two types of EUS core needles

et al. 2020

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Background and study aims We compared the diagnostic yield and specimen adequacy in EUS-guided parenchymal biopsies between two types of EUS 19 G core needles. Patients and methods This is a retrospective study of 420 patients at two tertiary medical centers in Florida with unexplained abnormal liver associated tests were referred for EUS evaluation of biliary obstruction and pancreatic pathology. EUS-guided liver biopsy (EUS-LB) was performed at the same session after biliary obstruction was excluded. We compared intact specimen length (ISL), total specimen length (TSL), complete portal triads (CPT) and adverse events (AE). Welch’s T and Tukey tests were used for ISL, TSL and CPT. Results A total of 210 patients underwent EUS-LB using a Franseen needle, 210 patients using a fork-tip needle. Median patient age was 52 years (15.63) and 238 (56.7 %) were female. The fork-tip needle had a mean ISL of 2.7 (1.1 SD) cm, TSL of 6 cm (2.1 SD), and mean 19.5 CPT (8.5 SD) Abdominal pain occurred in 35 patients (17 %) post-procedure and was managed with supportive care. Two patients required intravenous (IV) narcotic administration. Subcapsular hematomas occurred in 1 (0.5 %) patients. The Franseen needle had a mean ISL of 3.1 cm (1.3 SD), TSL of 6.5 cm (2.6 SD), and mean of 24 CPT (8.8 SD). Abdominal pain occurred in four patients (2 %) post-procedure, which resolved in all patients after IV narcotic administration. Subcapsular hematomas occurred in 1 (0.5 %) and bile leak in 1(0.4 %) patients. Conclusions Use of the Franseen needle resulted in better liver core samples than that obtained with a fork-tip needle.

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Section: Discussionmentioning

confidence: 92%

EUS-guided fine-needle core liver biopsy with a modified one-pass, one-actuation wet suction technique comparing two types of EUS core needles

et al. 2020

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“…The first published cases of EUSLB were described in 2007 using a novel Tru-Cut core biopsy needle (QuickCore; Cook Medical, Winston Salem, NC, USA). 18,48 Since the introduction of the first EUSLB, many studies have been performed to determine the preferred needle. Schulman et al sought to assess 6 needle types: 19 G (SharkCore FNB [Medtronic], 17 This previous study found that the 19 G SharkCore FNB needle provided superior histologic yield compared to existing percutaneous needles.…”

Section: Evolution Of Endoscopic Ultrasound-guided Liver Biopsy Technmentioning

confidence: 99%

Endoscopic Ultrasound-Guided, Percutaneous, and Transjugular Liver Biopsy: A Comparative Systematic Review and Meta-Analysis

et al. 2020

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Background/Aims: Percutaneous liver biopsy (PCLB) or transjugular liver biopsy (TJLB) have traditionally been performed to obtain a sample of hepatic tissue; however, endoscopic ultrasound-guided liver biopsy (EUSLB) has become an attractive alternative. The aim of this study was to compare the efficacy and safety of EUSLB, PCLB, and TJLB. Methods: Search strategies were developed in accordance with PRISMA and MOOSE guidelines. Major outcomes included the following: adequacy of biopsy specimens (i.e., complete portal triads [CPT], total specimen length [TSL] in mm, and length of longest piece [LLP]) in mm), and rate of adverse events. Only studies comparing all biopsy approaches (i.e., EUSLB, PCLB, and TJLB) were included. Results: Five studies (EUSLB [n=301]; PCLB [n=176]; and TJLB [n=179]) were included. Biopsy cumulative adequacy rates for EUSLB, PCLB, and TJLB were 93.51%, 98.27%, and 97.61%, respectively. Based on the subgroup analysis limited to EUS biopsy needles in current clinical practice, there was no difference in biopsy adequacy or adverse events for EUSLB compared to PCLB and TJLB (all p>0.050). A comparison of EUSLB and PCLB revealed no difference between specimens regarding both CPT (p=0.079) and LLP (p=0.085); however, a longer TSL (p<0.001) was observed. Compared to TJLB, EUSLB showed no difference in LLP (p=0.351), fewer CPT (p=0.042), and longer TSL (p=0.005). Conclusions: EUSLB appears to be a safe, minimally invasive procedure that is comparable to PCLB and TJLB regarding biopsy specimens obtained and rate of adverse events associated with each method.

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“…Compared with the previously discussed techniques, EUS-LB offers multiple advantages including real-time, high-resolution image guidance, visualization of the needle tract during entire procedure, ability to target both lobes of liver, reduced pain and apprehension, better patient comfort, and shorter hospital stay. [10][11][12][13] Additionally, it also provides opportunity to measure the portal venous pressure and perform elastography during the same session. 14,15 EUS-LB can also be feasible in patients with morbid obesity and ascites where percutaneous biopsy is contraindicated.…”

mentioning

confidence: 99%

“…21 Since then, several needle types (19G FNA, 19G FNB, and 22G FNB) have been evaluated in prospective and retrospective studies with variable tissue yields and fragmentation rates. 11 Similarly, different biopsy techniques have been developed in attempts to further increase the yield and reduce tissue fragmentation, including "dry suction," "dry heparin," and "wet suction." 22 There are limited prospective studies available offering direct comparison between needle types and sizes.…”

mentioning

confidence: 99%

“…Therefore, samples adequate for pathological interpretation could be obtained in only 60% cases (compared with 90% with 19G needle) and there was no additional safety benefit with smaller needle. 11,23 However, due to lack of adequate prospective randomized trials for direct comparison of needle types, size, and techniques, there is no consensus yet regarding the best needle for performing EUS-LB. In this edition of "News" we discuss two recently published articles exploring this important issue.…”

mentioning

confidence: 99%

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