Endoscopic ultrasound-guided tissue acquisition for focal liver lesions can be safely performed in patients with ascites

Abstract

Background and study aims In patients with ascites, percutaneous liver biopsy is generally contraindicated. Because endoscopic ultrasound-guided tissue acquisition (EUS-TA) allows tissue sample obtention from the digestive tract lumen, a biopsy without the intervention of ascites may prevent adverse events (AEs). This study aimed to evaluate the safety of EUS-TA for focal liver lesions in the presence of ascites.

Patients and methods A retrospective study was conducted using medical records of cases in which EUS-TA was performed on focal liver lesions between 2016 and 2022. Study participants were classified into two groups: those with ascites and those without it, and the outcomes were compared. The primary outcome was AEs.

Results We included 109 cases of EUS-TA for focal liver lesions. Ascites was present in 20.1% of cases (22/109) and absent in 79.8% of cases (87/109). There were no significant differences between the two groups in clinical backgrounds and EUS-TA procedure, although fine-needle biopsy needles were significantly more frequently used in patients without ascites. In the ascites group, puncture without intervening ascites was successful in 90.9% of cases (20/22). The incidence of AEs was 4.5% (1/22) in the ascites group and 1.1% (1/87) in the non-ascites group, showing no significant difference. The two AEs were mild self-limiting abdominal pain.

Conclusions In focal liver lesions with ascites, EUS-TA allows biopsy without the intervention of ascites in most cases. The incidence of AEs did not differ significantly between patients with and without ascites.

Keywords

Endoscopic ultrasonography - Tissue diagnosis - Fine-needle aspiration/biopsy - Biliary tract - Intervention EUS

Publication History

Received: 09 August 2024

Accepted after revision: 23 September 2024

Accepted Manuscript online:
30 September 2024

Article published online:
18 November 2024

• References

• 1 Piccinino F, Sagnelli E, Pasquale G. et al. Complications following percutaneous liver biopsy. A multicentre retrospective study on 68,276 biopsies. J Hepatol 1986; 2: 165-173
• 2 Rockey DC, Caldwell SH, Goodman ZD. et al. Liver biopsy. Hepatology 2009; 49: 1017-1044
• 3 Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med 2001; 344: 495-500
• 4 Neuberger J, Patel J, Caldwell H. et al. Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology. Gut 2020; 69: 1382-1403
• 5 Smayra K, Miangul S, Yap N. et al. Technical success, sample adequacy, and complications of pediatric transjugular liver biopsy: A systematic review and meta-analysis. Dig Dis Sci 2023; 68: 3846-3856
• 6 Tantău A, Sutac C, Pop A. et al. Endoscopic ultrasound-guided tissue acquisition for the diagnosis of focal liver lesion. World J Radiol 2024; 16: 72-81
• 7 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
• 8 Fujimoto K, Fujishiro M, Kato M. et al. Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. Dig Endosc 2014; 26: 1-14
• 9 Murphy FB, Barefield KP, Steinberg HV. et al. CT- or sonography-guided biopsy of the liver in the presence of ascites: frequency of complications. AJR Am J Roentgenol 1988; 151: 485-486
• 10 Little AF, Ferris JV, Dodd 3rd GD. et al. Image-guided percutaneous hepatic biopsy: effect of ascites on the complication rate. Radiology 1996; 199: 79-83
• 11 Nguyen P, Feng JC, Chang KJ. Endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration (FNA) of liver lesions. Gastrointest Endosc 1999; 50: 357-361
• 12 tenBerge J, Hoffman BJ, Hawes RH. et al. EUS-guided fine needle aspiration of the liver: Indications, yield, and safety based on an international survey of 167 cases. Gastrointest Endosc 2002; 55: 859-862
• 13 DeWitt J, LeBlanc J, McHenry L. et al. Endoscopic ultrasound-guided fine needle aspiration cytology of solid liver lesions: A large single-center experience. Am J Gastroenterol 2003; 98: 1976-1981
• 14 Hollerbach S, Willert J, Topalidis T. et al. Endoscopic ultrasound-guided fine-needle aspiration biopsy of liver lesions: Histological and cytological assessment. Endoscopy 2003; 35: 743-749
• 15 McGrath K, Brody D, Luketich J. et al. Detection of unsuspected left hepatic lobe metastases during EUS staging of cancer of the esophagus and cardia. Am J Gastroenterol 2006; 101: 1742-1746
• 16 Prachayakul V, Aswakul P, Kachintorn U. EUS guided fine needle aspiration cytology of liver nodules suspicious for malignancy: Yields, complications and impact on management. J Med Assoc Thai 2012; 95: S56-S60
• 17 Lee YN, Moon JH, Kim HK. et al. Usefulness of endoscopic ultrasound-guided sampling using core biopsy needle as a percutaneous biopsy rescue for diagnosis of solid liver mass: Combined histological-cytological analysis. J Gastroenterol Hepatol 2015; 30: 1161-1166
• 18 Oh D, Seo DW, Hong SM. et al. Endoscopic ultrasound-guided fine-needle aspiration can target right liver mass. Endosc Ultrasound 2017; 6: 109-115
• 19 Choi HJ, Moon JH, Kim HK. et al. KRAS mutation analysis by next-generation sequencing in endoscopic ultrasound-guided sampling for solid liver masses. J Gastroenterol Hepatol 2017; 32: 154-162
• 20 Ichim VA, Chira RI, Mircea PA. Diagnostic yield of endoscopic ultrasound-guided biopsy of focal liver lesions. Med Pharm Rep 2019; 92: 15-20
• 21 Chon HK, Yang HC, Choi KH. et al. Endoscopic ultrasound-guided liver biopsy using a core needle for hepatic solid mass. Clin Endosc 2019; 52: 340-346
• 22 Akay E, Atasoy D, Altınkaya E. et al. Endoscopic ultrasound-guided fine needle aspiration using a 22-G needle for hepatic lesions: Single-center experience. Clin Endosc 2021; 54: 404-412
• 23 Takano Y, Noda J, Yamawaki M. et al. Comparative study of an ultrasound-guided percutaneous biopsy and endoscopic ultrasound-guided fine-needle aspiration for liver tumors. Intern Med 2021; 60: 1657-1664
• 24 Takano Y, Yamawaki M, Noda J. et al. Endoscopic ultrasound-guided tissue acquisition for focal liver lesions in the caudate lobe: a report of seven cases. Clin J Gastroenterol 2024; 17: 334-337
• 25 Ali AH, Nallapeta NS, Yousaf MN. et al. EUS-guided versus percutaneous liver biopsy: A prospective randomized clinical trial. Endosc Ultrasound 2023; 12: 334-341