Endoscopic Ultrasound-Guided Fine Needle Core Liver Biopsy Using a Novel 19 G Needle with a Modified Wet Suction Technique in Patients with Abnormal Liver Function Tests: 2016 ACG Presidential Poster Award

Abstract

Introduction: Endoscopic Ultrasound-guided Fine Needle Core Biopsy has proven to be safe and effective technique for diagnosis of focal liver lesions. However, data are limited in its role in parenchymal disease. We evaluated the utility of EUS-guided parenchymal liver biopsies (LB) and documented adverse events (AE) using a novel 19G needle (Sharkcore, Medtronic) with a modified wet suction technique in patients (pts) referred for abnormal liver function tests (LFTs).Figure 1Figure 2Figure 3Methods: This was a single-center retrospective study of pts with unexplained abnormal LFTs who were referred for EUS of elevated LFTs to evaluate for biliary obstruction and pancreatic pathology. EUS-LB was performed at the same session after biliary obstruction was excluded. EUS-LB was performed using a modified wet suction technique. The needle was primed with saline and maximal suction was used. A rapid-puncture technique was used to sample each lobe for a total of one pass per lobe. Acquired tissue was placed into formalin, then stained with Hematoxylin and Eosin, Trichrome, and iron. The specimen length was assessed grossly and the number of complete portal triads (CPT) was determined on microscopic examination. Results: 105 consecutive pts underwent EUS-LB and data were retrospectively evaluated. Median age was 52 years (21-81) and 48 (45%) were male. The main indication was elevated LFTs with no signs of biliary obstruction, and absence of pancreas pathology during EUS. Adequacy of specimen for diagnosis was obtained in 100% of cases. Two pts previously underwent percutaneous LB, which were nondiagnostic. 25% of pts had undergone MRI elastography to assess degree of fibrosis. EUS-LB changed the fibrosis score in 54% of these pts, and altered the treatment course. The average maximum core tissue length was 2.5 cm, with a median of 16 CPT (7-35). Abdominal pain occurred in 35 pts (33.3%) immediately post-procedure, which resolved in all pts after intravenous administration of a low-dose narcotic. There was one early adverse event; a patient presented within 48 hours to the emergency room with worsened LFTs and abdominal pain. CT was normal and there was improvement in LFTs and abdominal pain in less than 24 hours. Conclusion: EUS-LB using a new needle proved to be safe with a low AE rate, and produced adequate samples measured by number of CPT and tissue specimen length. Diagnostic yield was achieved in 100% of patients and changed patient management in 12% of pts, with alteration in prior MRI fibrosis scores in half.