High yield of same-session EUS-guided liver biopsy by 19-gauge FNA needle in patients undergoing EUS to exclude biliary obstruction

• Published in: Gastrointestinal endoscopy Vol. 75; no. 2; pp. 310 - 318
• Main Authors: Stavropoulos, Stavros N., MD, Im, Gene Y., MD, Jlayer, Zahra, MD, Harris, Michael D., MD, Pitea, Teodor C., MD, Turi, George K., MD, Malet, Peter F., MD, Friedel, David M., MD, Grendell, James H., MD
• Format: Journal Article
• Language: English
• Published: Maryland heights, MO Mosby, Inc 01-02-2012; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Biopsy, Fine-Needle - adverse effects; Biopsy, Fine-Needle - instrumentation; Biopsy, Fine-Needle - methods; Cholestasis - complications; Cholestasis - diagnostic imaging; Cholestasis - pathology; Digestive system; Digestive system. Abdomen; Endoscopy; Endosonography; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Liver Diseases - diagnostic imaging; Liver Diseases - etiology; Liver Diseases - pathology; Liver Function Tests; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Prospective Studies; Ultrasonography, Interventional - adverse effects; complete portal tract; INR; international normalized ratio; CPT; EUS-FNA; EUS-guided FNA; Sonography; Human; Liver biopsy; Fine needle; Endoscopic route; Endoscopic ultrasonography; Echography; Digestive diseases; Biliary tract disease; Aspiration punction; Biliary tract obstruction
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2011.09.043

Background EUS-guided liver biopsy by Trucut yields variable specimen adequacy at high cost, limiting its utility. A modified EUS-guided technique with reliable adequacy could be a viable alternative to standard techniques in cost-effective clinical settings. Objective To describe our experience with EUS-guided liver biopsy by 19-gauge FNA, non-Trucut, needle in a cost-effective setting: patients with abnormal liver test results of unclear etiology referred for EUS to exclude biliary obstruction in whom an unrevealing EUS would have prompted a next-step liver biopsy by the referring physician. Design Prospective case series. Setting Tertiary-care teaching hospital. Patients Consecutive patients with abnormal liver tests referred for EUS. Interventions EUS-guided liver biopsy by 19-gauge FNA needle (non-Trucut). Main Outcome Measurements Diagnostic yield, specimen adequacy, and complications. An adequate specimen was defined as a length of 15 mm or longer and 6 or more complete portal tracts (CPTs). Results Between July 2008 and July 2011, 22 of 31 consecutive patients meeting inclusion criteria underwent unrevealing EUS with same-session EUS-guided liver biopsy by 19-gauge FNA needle. A median of 2 FNA passes (range 1-3) yielded a median specimen length of 36.9 mm (range 2-184.6 mm) with a median of 9 CPTs (range 1-73 CPTs). EUS-guided liver biopsies yielded a histologic diagnosis and adequate specimens in 20 of 22 patients (91%). Expanded experience led to improved specimen adequacy. There were no complications. Limitation Small study size. Conclusions EUS-guided liver biopsy by using a 19-gauge FNA needle appears to be feasible and safe and provides excellent diagnostic yield and specimen adequacy.