Our initial experiences with endoscopic ultrasound examinations in diffuse liver diseases

Introduction: One of the greatest diagnostic challenges in everyday medical practice is to evaluate the extent of liver fibrosis in diffuse liver diseases. Blind – percutaneous – liver biopsy is considered to be today's „gold standard”, which provides invaluable information for the diagnosis and prognosis of the disease and for the selection of treatment strategy. However, blind liver biopsy obtained from the sample is often not representative of the liver as a whole (it only provides valuable information for 1/50.000 part of the liver). Other disadvantages include the heterogeneous distribution of fibrosis, as well as the possibilities of complications and the expenses of the intervention. The FibroScan test is a recent promising diagnostic technique based on the principle of transient elastography. It allows for the analysis of a tissue sample size of approximately a 100 times larger than the tissue sample obtained with blind biopsy whilst using a non-invasive technique. However, these test are of limited availability and are relatively costly and even these tests do not provide valuable information in 2% to 16% of the cases.

Aim: In view of the above, real time tissue elastography performed during endoscopic ultrasound examinations was used as an alternative diagnostic technique to assess whether this method can be used to evaluate the extent of liver fibrosis in diffuse liver disease.

Materials and methods: The examinations were performed using the following devices: Pentax EG-3870UTK linear echoendoscope and Hitachi HI VISON ultrasound.

Results: During our short test period we compared the results of 7 patients receiving treatment for diagnosed liver cirrhosis to the results of normal control.

Conclusions: Based on the limited number of cases involved in our study, our initial results are promosing. The spectral analysis data shows a clear correlation between the distribution of the blue color – indicating rigid structures – and the extent of tissue fibrosis. Although the examintaion itself is minimally invasive, it can be performed in an ambulatory setting, and it is not influenced by constitutional characteristics. Notwithstanding that a further prospective controlled study would be expedient, we believe the method itself could be appropriate for the quantitative evaluation of the extent of liver fibrosis using minimally invasive techniques.