Endoscopic ultrasound-guided liver biopsy: a multicenter experience

Abstract

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.

Fig. 1

EUS-LB using fine needle aspiration (19-gauge needle). a The left lobe of the liver. b The right lobe of the liver.

Fig. 2

Tissue was expressed into the formalin container. a Visible core. b More bloody specimens; the contents of the container were poured into a petri dish. c The formalin-fixed pieces of liver tissue, distinguished from blood clot, were removed with forceps. d Next, the tissue was wrapped in lens paper and placed into a histology cassette for standard processing; the blood clot was also submitted. Usually, all material was processed in a single cassette.

Fig. 3

Precise quantification of liver core lengths. a Digital measurements. b Representative photomicrographs showing liver tissue mixed with blood clot obtained from patients from this series. c Duodenal mucosa with right lobe EUS-LB; d Autoimmune hepatitis under high power view. e Steatohepatitis. f Non-caseating granulomatous hepatitis.