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DOI: 10.1055/s-0034-1391412
Endoscopic ultrasound-guided liver biopsy: a multicenter experience
Publication History
submitted 05 December 2014
accepted after revision 24 December 2014
Publication Date:
27 February 2015 (online)
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.
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References
- 1 Rockey DC, Caldwell SH, Goodman ZD et al. AASLD Position Paper: Liver Biopsy. Hepatology 2009; 49: 1017-1044
- 2 Kalambokis G, Manousou P, Vibhakorn S et al. Transjugular liver biopsy - Indications, adequacy, quality of specimens, and complications - A systematic review. J Hepatol 2007; 47: 284-294
- 3 Mathew A. EUS-guided liver biopsy in select patients. Am J Gastroenterol 2007; 102: 2354-2355
- 4 Gleeson FC, Clayton AC, Zhang L et al. Adequacy of endoscopic ultrasound core needle biopsy specimen of nonmalignant hepatic parenchymal disease. Clin Gastroenterol Hepatol 2008; 6: 1437-1440
- 5 Dewitt J, McGreevy K, Cumming O et al. Initial experience with EUS-guided Tru-cut biopsy of benign liver disease. Gastrointest Endosc 2009; 69: 535-542
- 6 Stavropoulos SN, Im GY, Jlayer Z et al. High yield of same-session EUS-guided liver biopsy by 19-gauge FNA needle in patients undergoing EUS to exclude biliary obstruction. Gastrointest Endosc 2012; 75: 310-318
- 7 Nakai Y, Samarasena JB, Iwashita T et al. Autoimmune hepatitis diagnosed by endoscopic ultrasound-guided liver biopsy using a new 19-gauge histology needle. Endoscopy 2012; 44: E67-E68
- 8 Adler DG, Jacobson BC, Davila RE et al. ASGE Guideline: complications of EUS. Gastrointest Endosc 2005; 61: 8-12
- 9 Maharaj B, Maharaj RJ, Leary WP et al. Sampling variability and its influence on the diagnostic yield of percutaneous needle biopsy of the liver. Lancet 1986; 1: 523-525
- 10 Gor N, Salem SB, Jakate S et al. Histological adequacy of EUS-guided liver biopsy when using a 19-gauge non-Tru-Cut FNA needle. Gastrointest Endosc 2014; 79: 170-172
- 11 Musso G, Gambino E, Cassader M et al. Meta-analysis: natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity. Ann Med 2011; 43: 617-649