873 Gastric Findings During Endoscopic Ultrasound (EUS)-Guided Liver Biopsy

Abstract

INTRODUCTION: Endoscopic ultrasound (EUS)-guided liver biopsy has recently emerged as an alternative approach to obtain liver biopsy with a low adverse event profile. With the new dedicated 19-gauge EUS core biopsy needle, it is shown that the procedure is safe and provides excellent diagnostic yield with a minimal number of passes. This is of particular importance, given the rise in the metabolic syndrome paralleling the increase in the diagnosis of non-alcoholic fatty liver disease (NAFLD). EUS-guided liver biopsy requires transgastric or transduodenal needle passage to obtain core needle biopsies from left and right lobes of the liver, respectively. However, given the nature of its transmural path, unexpected histopathological results can be seen from gastric tissue acquired during transgastric needle passage. Here we describe incidental and interesting gastric findings obtained during transgastric EUS-guided liver biopsies. METHODS: A retrospective analysis of a prospectively maintained database of all patients undergoing EUS-guided liver biopsy from 01/2017 to 11/2018 was performed. Transgastric liver biopsies were obtained using a 19-gauge core biopsy needle with application of 10 ml suction. The syringe piston was locked into this position for continuous suction. The needle was moved to and fro 2-3 times inside the liver parenchyma under complete endosonographic control. All specimens were recovered, fixed in formalin, and processed for histological analysis. Additional non-hepatic tissue findings were analyzed for any clinically relevant histopathologic diagnosis. RESULTS: A total of 28 patients (mean age 48 ± 14 years; 57% females) were included. The median number of passes was 2 (range 1-3, mean 2). The mean total sample length was 24.5 ± 8.32 mm. Biopsy specimen was adequate for liver histology in all patients. Six patients had additional unexpected histopathological results from gastric tissue acquired during the transgastric needle passage. Four patients were found to have chronic active gastritis with Helicobacter pylori as a “gastric contaminant” on the liver biopsy specimens. One patient had atrophic gastritis and one patient was noted to have autoimmune gastritis further confirmed on serology. There were no reported complications from the procedures. All patients were then subsequently managed for incidentally noted findings. CONCLUSION: This study shows that transgastric EUS-guided liver biopsies can result in incidental bystander gastric diagnoses with clinical importance.