EUS-Guided Liver Fine Needle Biopsy With a 19-Gauge SharkCore Needle in Patients Undergoing EUS to Evaluate for Biliary Disease

Abstract

Introduction: Non Malignant Liver biopsies are currently performed via a percutaneous approach and transjugular approach. EUS guided liver fine needle Aspiration FNA of non malignant liver disease has been reported in the literature. EUS guided liver biopsy using a novel 19 Gauge Fine Needle Biopsy (FNB) (SharkCore, Medtronic) offers an alternative to produce a biopsy with preserved tissue architecture. Our aim is to describe the initial experience using a novel FNB needle in the evaluation of liver disease in patients undergoing EUS for biliary disease evaluation in the setting of abnormal liver function tests. Methods: This is a retrospective case series from April 2015 to May 2015, in a tertiary medical center of patients referred for EUS evaluation of biliary disease in the setting of abnormal liver function tests. We reviewed six patients with abnormal liver function tests, who had normal biliary EUS evalutions. Two passes with 19 Gauge FNB SharkCore needle using the saline wet technique and high suction (20cc) were used. The specimens were put in formalin and sent for pathology evaluation, number of intact portal triads, intact core specimen length, stage and grade of liver disease. Post EUS FNB complications were monitor at one week follow up.Figure 1Figure 2Figure 3Results: We evaluated 6 EUS guided FNB liver biopsies in 6 patients (50% women), ages (33-76) with abnormal liver function tests and a normal biliary EUS evaluation. The pathology was consistent with alcohol liver disease (33.3%), drug induced liver toxicity (16.7%), autoimmune liver disease (16.7%), and NASH (33.3%). The mean number of intact portal tracts 9.83 (range 7-18), all specimens where adequate for pathological evaluation. Median intact core specimen length was 34.4 mm (range 21mm to 65.9mm). The average grade of liver disease 1.7 (range 1-2) and stage 2.2 (range 0-3). Post EUS FNB 33.3% of patient complained of right upper quadrant pain and all resolved after one dose of pain medication. There were no reported complications and persistent pain at one week follow up. Conclusion: A novel EUS guided FNB 19 G needle (SharkCore) provided adequate pathological yield and safety profile. EUS guided FNB is an alternative to liver biopsy in patients undergoing EUS for biliary disease exclusion, it provides adequate tissue architecture it is relatively safe. Larger prospective studies are needed to fully understand the role of EUS guided liver FNB.