Endoscopic ultrasound-guided tissue acquisition for focal liver lesions can be safely performed in patients with ascites

Abstract

Background and study aim: In patients with ascites, percutaneous liver biopsy is generally contraindicated. Since endoscopic ultrasound-guided tissue acquisition (EUS-TA) allows tissue sample obtention from the digestive tract lumen, a biopsy without the intervention of ascites may prevent adverse events. This study aimed to evaluate the safety of EUS-TA for focal liver lesions in the presence of ascites. Patients and methods: A retrospective study was conducted using medical records of cases in which EUS-TA was performed on focal liver lesions between 2016 and 2022. Study participants were classified into two groups: those with ascites and those without it, and the outcomes were compared. The primary outcome was adverse events. Results: We included 109 cases of EUS-TA for focal liver lesions. Ascites was present in 20.1% (22/109) of cases and absent in 79.8% (87/109) of cases. There were no significant differences between the two groups in clinical backgrounds and EUS-TA procedure, although fine needle biopsy needles were significantly more frequently used in patients without ascites. In the ascites group, puncture without intervening ascites was successful in 90.9% (20/22) of cases. The incidence of adverse events was 4.5% (1/22) in the ascites group and 1.1% (1/87) in the non-ascites group, showing no significant difference. The two adverse events were mild self-limiting abdominal pain. Conclusions: In focal liver lesions with ascites, EUS-TA allows biopsy without the intervention of ascites in most cases. The incidence of adverse events did not differ significantly between patients with and without ascites.