S0948 EUS-Guided Liver Biopsy in Pediatric Patients Compared to Percutaneous Liver Biopsy: Case-Matched Study

Abstract

INTRODUCTION: EUS–modified liver biopsy (EUS-MLB) can be a valuable tool in determining the etiology of pediatric liver disease. Liver biopsies (LB) traditionally have been performed percutaneously (PC). However, data is limited in the role of EUS-MLB in children. We evaluated the efficacy and the safety of a modified technique (MLB) in pediatric patients. Additionally, we aimed to compare tissue yield of the EUS-MLB and PC approaches. METHODS: A retrospective analysis of EUS-MLB in pediatric patients with unexplained liver function test abnormalities after the exclusion of biliary obstruction in a tertiary referral center from march-2017 to August-2018 was completed. All pediatric patients were referred for EUS-MLB and PC-LB. EUS-MLB consists in a one pass wet suction technique using 19g core needle (Figure 1). Comparisons of total specimen length (TSL), intact specimen length (ISL) and the count of complete portal triads (CPTs) between the groups were done using student’s T-test. RESULTS: There were 7 EUS-MLB and 7 PC-LB pediatric cases (11/14, 78.0% male). The median (IQR) age was 14.5 years (13.4–16.0). The median of the TSL was 8.6 cm (IQR 5.8–9.6) in EUS-MLB cases and 7.0 cm (IQR 7–9) in PC-LB cases (P = 0.05). The maximum intact specimen was 5.9 cm (EUS-MLB) and 2.2 cm (PC-LB) (P = 0.05). The mean (SD) number of CPTs per sample was 28.2 (7.3) and 11.6 (2.1), respectively (P = 0.05). Patient diagnoses included no pathology (3/14, 21.4%), non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (6/14, 42.8%), hepatitis C infection (1/14, 7.1%), drug induced liver injury (2/14, 14.3%), autoimmune hepatitis (1/14, 7.1%) and intrahepatic cholestasis (1/14, 7.1%). Adverse events were uncommon (1/14, 7.1%) and included self-limited abdominal pain in the PC-LB group. CONCLUSION: EUS-MLB was shown to have higher numbers of TSL, ISL and CPTs when directly compared to PC-LB. It has the potential to be a safe and more effective alternative approach in the evaluation of pediatric patients with unexplained liver function test abnormalities who undergo EUS to evaluate biliary complications.Figure 1.: Live view of parenchymal tissue obtained via EUS.