864 Simultaneous Biliary and Liver Parenchymal Evaluation in Post Liver-Transplant Population Using Endoscopic Ultrasound-Guided Liver Biopsy and Endoscopic Retrograde Cholangiopancreatography in a Single Session Approach

Abstract

INTRODUCTION: Liver test elevations occur post-liver transplantation (LTx) secondary to a variety of etiologies including parenchymal, biliary or vascular dysfunction. Workup often includes a multi-step evaluation including imaging, liver biopsy and evaluation of the biliary system. Endoscopic ultrasound-guided fine needle biopsy of the liver (EUS-LB) is a novel technique that has been shown to be safe and effective. Herein, we report our experience with a single-session EUS-LB coupled with endoscopic retrograde cholangiopancreatography (ERCP) in the evaluation of abnormal liver function tests in the post-LTx population. METHODS: This is a retrospective analysis of electronic medical record over 2-year period (1/2017 – 5/2019). EUS-LB was performed in addition to ERCP for the evaluation and treatment of elevated liver tests and suspected biliary abnormality. EUS-LB was obtained using 19-gauge core biopsy needle (Sharkcore, Medtronic, Sunnyvale, CA. or Acquire, Boston Scientific, Marlborough, MA.) via modified one pass, one actuation wet suction technique. RESULTS: Thirty-nine patients underwent simultaneous EUS-LB and ERCP (mean age 52 ± 15 years; 62% female; mean BMI 27) after an average of 61 (1-432) weeks post-LTx. Nineteen patients (49%) were on aspirin. The mean EUS-LB and ERCP procedure time were 15 ± 12 and 21 ± 13 minutes respectively. EUS-LB was performed from a single lobe in 29 patients (74%) via 1 pass in 23 patients and 2 or 3 passes in the remainder. Ten patients (26%) underwent EUS-LB via 2 or 3 passes of both lobes. Adequate yield for histopathology in 37 of 39 (95%). Two specimens were inadequate due to defective needles. The mean specimen aggregate length was 30 ± 19 mm, longest intact core was 19 ± 11 mm and complete portal tracts were 16 ± 7.8. ERCP abnormalities were anastomotic stricture (33; 84.6%), debris (5; 12.8%), choledocholithiasis (4; 10.3%), and biliary leak (2; 5.1%). Histology demonstrated acute rejection (10; 27.0%), cholestasis (11; 29.7%), non-specific hepatitis (12; 32.4%), chronic rejection (2; 5.4%), and alcoholic hepatitis (1; 2.7%). Procedural complications were pancreatitis (2; 5.1%), cholangitis due to occluded stent (1; 2.6%), and hematoma requiring transfusion but no intervention (1; 2.6%). CONCLUSION: Simultaneous EUS-LB and ERCP evaluation of post-LTx patients is an effective technique for the assessment of abnormal liver function tests, obviating the need for separate evaluations with potential delays of care and prolonged hospitalization.