Endoscopic ultrasound-guided liver biopsy: a multicenter experience

Abstract

Introduction: Endoscopic ultrasound-guided liver biopsy (EUS-LB) is a newer method of liver biopsy which offers several advantages over existing techniques including real-time visualization of the liver and its vascular structures, increased patient comfort, and ability to sample both lobes. In patients already undergoing EGD/EUS, EUS-LB can spare the patient from having to undergo an additional procedure. However, there is limited data in the literature regarding the safety and efficacy of EUS-LB. Our goal is further characterize the diagnostic yield and safety profile of EUS-LB on a larger scale. Methods: Patients undergoing EGD/EUS with an indication for LB were included in this prospective, non-randomized, multi-center study. Elevated LFTs was the indication for LB in all patients. Patient demographics, procedure information, diagnostic yield, specimen adequacy, and complications rates were recorded. Patients were called 30 days post-procedure to check for procedurerelated complications. LB was done with 19 g EUS-FNA needle (19g Expect or Expect Flexible, Boston Scientific, Marlborough, MA). 1 or 2 passes were made in the left lobe depending on endoscopist's preference or assessment of tissue yield after the first pass. Right lobe FNA was done as per endoscopist's preference. Tissue was formalin-fixed and stained with H&E and trichrome. Using a microscope micrometer, specimen length was measured and number of complete portal triads (CPTs) counted. Results: 38 patients underwent EUS-LB. The indication was abnormal LFTs in all cases. Half of the patients were male, with mean age of 52.4yr (31-79). LB specimens sufficient for pathological diagnosis were obtained in 37 of 38 patients (97.4%). 36 of needle passes were performed under suction, while 2 were performed without suction, with respective success rates of 36 of 36 (100%), and 1 of 2 (50%). 28 of 38 (74%) patients had bilateral lobar biopsies; 10 had only the left lobe sampled. Left-lobar biopsies had a mean aggregate length of 26 mm (1-75), and mean of 8.9 CPTs (0-30). Right-sided biopsies tended to be somewhat smaller (mean aggregate length of 18 mm (3-44), 6.5 CPTs, range 0-29). 8 or more total CPTs were obtained in 82% of patients. One complication occurred (1/38, 2.6%). Bleeding in a thrombocytopenic and coagulopathic (platelets 64K, INR 1.4) inpatient being evaluated for elevated LFTs was encountered. CT showed a pericapsular hematoma and angioembolization was required for hemostasis. No other patient had postprocedural bleeding, abdominal pain, or procedure-related issues at the 30 day telephone follow-up. Conclusion: EUS-LB can be performed successfully and safely in patients who are undergoing EGD or EUS and who are also going to undergo liver biopsy by other means. Tissue yields are acceptable for pathologic diagnosis in almost all biopsies.