Modified Endoscopic Ultrasound-Guided Liver Biopsy in Patients with or without Cirrhosis: Comparative Analysis of Adequacy, Safety, and Technical Determinants

Aims: Endoscopic ultrasound-guided liver biopsy (EUS-LB) for tissue acquisition in patients with cirrhosis has not been studied. We used a modified technique to compare the adequacy, safety and technical determinants with non-cirrhotics.

Methods: A prospective observational study was conducted from July to November 2023. Fifty consecutive patients underwent EUS-LB with 19G Franseen tip needle by wet heparinized suction. One or two passes with variable number of actuations were taken, endpoint being aspiration of blood. Primary outcomes were percentage of adequate tissue cores and definitive histologic diagnosis. Adequate specimen was defined as total specimen length (TSL) ≥20 mm and complete portal tracts (CPT) ≥11, only TSL criteria was used in advanced fibrosis. Secondary outcomes were correlation between number and depth of actuations with TSL and longest specimen length (LSL). Early and late adverse events (AEs) were also assessed. Comparative analysis of all outcomes were done in cirrhotic and noncirrhotic cohort identified by histological findings.

Results: Adequate samples and histologic diagnosis in non cirrhotics versus cirrhotics were seen in 27/27 (100%) versus 21/23 (91.3%), p = 0.206 and 27/27 (100%) versus 22/23 (95.65%), p = 0.46, respectively.

Similarly mean TSL, LSL, CPT, number of cores were 10.22 cm (±3.31) versus 5.33 cm (±2.15) p <0.0001, 2.28 cm (±0.70) versus 1.41 cm (±0.65) p <0.0001, 27.09 (±8.10) versus 20.94 (±10.20), p = 0.017, 10.03 (±3.88) versus 7.21 (±2.65) p = 0.012, respectively. CPT could not be counted in 8 patients due to stage 5 or 6 fibrosis. The correlation in noncirrhotics versus cirrhotics between TSL with number and depth of actuation were r = 0.71 versus 0.53 and r = 0.55 versus 0.51 and for LSL were r = 0.28 versus 0.11 and r = 0.74 versus 0.55. Minor AEs were seen in 6/27 versus 1/23, p = 0.0694 respectively.

Conclusions: This modified EUS-LB technique shows comparable adequacy, histological diagnosis, pain scores and safety in cirrhotics compared to noncirrhotic cohort.

Publication History

Article published online:
22 April 2024