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CC BY 4.0 · Endoscopy 2025; 57(S 01): E985-E986
DOI: 10.1055/a-2686-7833
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Endoscopic ultrasound-guided tissue acquisition of a focal liver lesion via the duodenum under fluoroscopic guidance

Yuichi Takano 
1   Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
,
Naoki Tamai
1   Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
,
Masataka Yamawaki
1   Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
,
Jun Noda
1   Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
,
Tetsushi Azami 
1   Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
,
Fumitaka Niiya 
1   Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
,
Masatsugu Nagahama
1   Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
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In recent years, endoscopic ultrasound-guided tissue acquisition (EUS-TA) has become increasingly common for evaluating focal liver lesions [1] [2]. However, accessing focal liver lesions from the duodenum remains technically challenging. Here, we report a case in which EUS-TA for a focal liver lesion was successfully performed via the duodenum by adjusting the orientation of the echoendoscope under fluoroscopic guidance.

The patient was a woman in her 60s. Abdominal contrast-enhanced magnetic resonance imaging revealed a 16-mm lesion in segment 4 of the liver ([Fig. 1]), and EUS-TA was scheduled for diagnostic assessment.

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Fig. 1 Abdominal contrast-enhanced magnetic resonance imaging revealed a 16-mm lesion in segment 4 of the liver (arrow).

A convex-array echoendoscope (GF-UCT260; Olympus Medical Systems, Tokyo, Japan) was advanced to the duodenal bulb. Initially, the probe was oriented caudally, preventing visualization of the liver ([Fig. 2] a). Under fluoroscopic guidance, the probe was directed toward the liver ([Fig. 2] b). The liver was clearly visualized, and the target lesion was successfully identified on the EUS image ([Fig. 3]) EUS-TA was performed using a 22-gauge fine-needle biopsy needle (SonoTip TopGain; Medico’s Hirata, Tokyo, Japan). No procedure-related adverse events occurred ([Video 1]).

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Fig. 2 Fluoroscopic imaging showing the convex-array echoendoscope at the duodenal bulb. a Initially, the probe was oriented caudally, preventing visualization of the liver (arrow). b Under fluoroscopic guidance, the probe was directed toward the liver (arrow).
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Fig. 3 A hyperechoic lesion with a peripheral hypoechoic rim was detected in segment 4 of the liver (arrow). Endoscopic ultrasound-guided tissue acquisition was performed.
Endoscopic ultrasound-guided tissue acquisition from a focal liver lesion via the duodenum under fluoroscopic guidance.Video 1

Histopathological analysis confirmed adenocarcinoma ([Fig. 4]). The patient was diagnosed with breast cancer liver metastasis and referred for systemic chemotherapy.

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Fig. 4 Histopathological analysis confirmed adenocarcinoma (hematoxylin and eosin staining, ×100). The patient was diagnosed with breast cancer liver metastasis and referred for systemic chemotherapy.

Visualization of focal liver lesions from the duodenum using EUS can be technically challenging. However, adjusting the orientation of the echoendoscope under fluoroscopic guidance allowed for precise lesion detection. This technique may be particularly useful for targeting focal liver lesions from the duodenal approach.

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Conflict of Interest

The authors declare that they have no conflict of interest.


Correspondence

Yuichi Takano, MD, PhD
Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital
1-30 Fujigaoka, Aoba, Yokohama
Kanagawa 227-8501
Japan   

Publication History

Article published online:
04 September 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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Zoom
Fig. 1 Abdominal contrast-enhanced magnetic resonance imaging revealed a 16-mm lesion in segment 4 of the liver (arrow).
Zoom
Fig. 2 Fluoroscopic imaging showing the convex-array echoendoscope at the duodenal bulb. a Initially, the probe was oriented caudally, preventing visualization of the liver (arrow). b Under fluoroscopic guidance, the probe was directed toward the liver (arrow).
Zoom
Fig. 3 A hyperechoic lesion with a peripheral hypoechoic rim was detected in segment 4 of the liver (arrow). Endoscopic ultrasound-guided tissue acquisition was performed.
Zoom
Fig. 4 Histopathological analysis confirmed adenocarcinoma (hematoxylin and eosin staining, ×100). The patient was diagnosed with breast cancer liver metastasis and referred for systemic chemotherapy.