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Endoscopic ultrasound-guided liver biopsy using a 22-G fine needle biopsy needle: a prospective study
submitted 24 February 2019
accepted after revision 16 May 2019
31 July 2019 (online)
Background Endoscopic ultrasound-guided liver biopsy (EUS-LB) using a 19-gauge (19-G) EUS needle is becoming increasingly popular. We evaluated the efficacy and safety of a 22-G EUS fine needle biopsy (FNB) needle for performing EUS-LB.
Methods Patients referred for evaluation of elevated liver enzymes and without obstructive disease requiring endoscopic retrograde cholangiopancreatography (ERCP) were included. Using a 22-G FNB needle, two passes were made from the left lobe and one from the right. The main outcome measure was adequacy of the specimen for histology interpretation, and the secondary outcome was the safety of EUS-guided liver biopsy with a 22-G FNB needle. Patients were followed for post-procedure complications for 30 days.
Results 40 patients (median age 61 years; 26 women) underwent EUS-LB. Analyzing by needle passes, the median longest core fragment was 12 mm (1st quartile – 3rd quartile 10 mm – 16.25 mm, interquartile range [IQR] 6.25 mm) from the left lobe and 11 mm (10 mm – 15.75 mm, IQR 5.75 mm) from the right lobe. The median cumulative core length per patient was 55 mm (44.5 mm – 68 mm, IQR 23.5 mm). The median cumulative number of complete portal triads (CPTs) per patient was 42 (28.5 – 53, IQR 24.5). The specimen was considered adequate in all 40 patients (100 %). Self-limiting abdominal pain was reported in 6 patients (15 %).
Conclusions EUS-LB using a 22-G FNB needle is a safe and viable alternative to the use of larger gauge needles, yielding adequate tissue for evaluation of parenchymal disease in 100 % of the patients.
- 1 Skelly MM, James PD, Ryder SD. Findings on liver biopsy to investigate abnormal liver function tests in the absence of diagnostic serology. J Hepatol 2001; 35: 195-199
- 2 Rockey DC, Caldwell SH, Goodman ZD. et al. American Association for the Study of Liver Disease. Liver biopsy. Hepatology 2009; 49: 1017-1044
- 3 Mohan BP, Shakhatreh M, Garg R. et al. Efficacy and safety of EUS-guided liver biopsy: a systematic review and meta-analysis. Gastrointest Endosc 2019; 89: 238-246
- 4 Mathew A. EUS-guided routine liver biopsy in selected patients. Am J Gastroenterol 2007; 102: 2354-2355
- 5 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
- 6 Dewitt J, McGreevy K, Cummings O. et al. Initial experience with EUS-guided Tru-cut biopsy of benign liver disease. Gastrointest Endosc 2009; 69: 535-542
- 7 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
- 8 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 (Suppl. 02) UCTN: E67-E68
- 9 Diehl DL, Johal AS, Khara HS. et al. Endoscopic ultrasound-guided liver biopsy: a multicenter experience. Endosc Int Open 2015; 3: E210-E215
- 10 Mok SRS, Diehl DL, Johal AS. et al. Endoscopic ultrasound-guided biopsy in chronic liver disease: a randomized comparison of 19-G FNA and 22-G FNB needles. Endosc Int Open 2019; 7: E62-E71
- 11 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
- 12 Nieto J, Khaleel H, Challita Y. et al. EUS-guided fine-needle core liver biopsy sampling using a novel 19-gauge needle with modified 1-pass, 1 actuation wet suction technique. Gastrointest Endosc 2018; 87: 469-475
- 13 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
- 14 Pineda JJ, Diehl DL, Miao CL. et al. EUS-guided liver biopsy provides diagnostic samples comparable with those via the percutaneous or transjugular route. Gastrointest Endosc 2016; 83: 360-365
- 15 Veitch AM, Vanbiervliet G, Gershlick AH. et al. Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Gut 2016; 65: 374-389
- 16 Fryer E, Wang LM, Verrill C. et al. How often do our liver core biopsies reach current definitions of adequacy?. J Clin Pathol 2013; 66: 1087-1089
- 17 Wang R, Wang J, Li Y. et al. Diagnostic accuracies of endoscopic ultrasound-guided fine-needle aspiration with distinct negative pressure suction techniques in solid lesions: A retrospective study. Oncol Lett 2017; 13: 3709-3716