SAFETY AND EFFICACY OF ENDOSCOPIC ULTRASOUND GUIDED LIVER BIOPSY (EUS–LB): AN INITIAL EXPERIENCE FROM TERTIARY CARE CENTER IN INDIA

Aims Liver biopsy(LB) – gold standard for evaluation of liver disorders. Traditional techniques–percutaneous(PCLB)/trans-jugular(TJLB)–inherent limitations/risks. TJLB-preferred in coagulopathy, expensive with limited availability. Endoscopic ultrasound guided liver biopsy(EUS-LB)–recently described, promising results. Study evaluates safety and efficacy of EUS-LB in undiagnosed liver disorders.

Methods Retrospective analysis of prospectively maintained database. Inclusions–EUS-LB for evaluation of undiagnosed liver diseases; Exclusions–EUS-LB for mass lesions. Propofol sedation;19G FNB needle; Left lobe targeted; 1 / 2 passes under EUS-Doppler guidance;<5 to-and-fro movements during each pass;dry heparin technique. Parameters evaluated–Total specimen length(TSL), complete portal triads(CPT), diagnostic yield, adverse events(AEs).

Results Study period–June-November2021. N=13;M:F–6:7;mean age–46.5(SD±15.4)years. Perceived risk of bleed, ascites or concomitant evaluation of obstructive biliary pathology preferred for EUS–LB. Clinico-radiological profile:pain–3,jaundice–6,fever–1,pruritus–2; coagulopathy–7/13;esophageal varices–4(Low risk–2;High risk–2). Ascites–6/13(46.1%); splenomegaly–5/13(38.4%); Mean PVdiameter–11.5(9–13.3)mm; HV flow–patent in 100%.

Technical success–13/13(100%). FNB target–segment 2–9 (w/o esophageal varices);segment 3– 4(varices). Single pass–5(38.5%),two passes–8(61.5%). Concomitant band ligation–2. Diagnostic yield–100%(13/13;AIH–4, PSC–3,AIH-PSC overlap–1,NASH–1,cirrhotic nodules–1,chronic cholangiopathy–1,chronic hepatitis–1,normal–1).Mean CPT–8.8(SD±2.03);mean TSL–9.3mm(SD±2.86);AE–minor bleed–1(7.6%; managed conservatively); pain–none; analgesic requirement–nil. Hospitalization–out-patient–5,day-care–5,in-patient–3.

Conclusions EUS–LB is safe and effective for liver sampling during EUS evaluation within diagnostic algorithms for liver diseases; high diagnostic yield. Concomitant evaluation of coexisting extrahepatic biliary pathology, portal hypertension, and variceal endotherapy can be effectively performed during same procedure. Larger prospective comparative studies recommended.

Publication History

Article published online:
14 April 2022