S0974 Post-Procedure Pain and Complications From Endoscopic Ultrasound-Guided Liver Biopsy Compared to Percutaneous Liver Biopsy for Benign Parenchymal Liver Disease

Abstract

INTRODUCTION: Endoscopic ultrasound guided liver biopsy (EUS-LB) has emerged as a viable method for core tissue acquisition. Because EUS-LB avoids puncture of the skin and underlying muscle and fascia, we hypothesized the technique would result in less post-procedure pain than percutaneous Liver biopsy (P-LB). METHODS: The study was a retrospective review of prospectively maintained EUS-LB and P-LB databases. Exclusion criteria were liver biopsy of a mass lesion, ascites, or coagulopathy (platelets < 50,000 or International Normalized Ratio > 1.5). EUS-LB was performed with a 19-gauge needle using wet suction with heparin or saline. P-LB was performed using a 16-gauge spring-loaded core biopsy needle. Following EUS-LB and P-LB, patients were monitored for 30 and 60 minutes respectively before discharge. Pre- and post-procedure pain location, severity (10-point numeric scale), and use of analgesics was documented in all patients. Patients were contacted within 1 week post-procedure, and the medical records were reviewed for up to 30 days-post procedure to assess for complications. The primary outcome was incidence of increased post-procedural pain. Secondary outcomes were proportion of patients who required analgesics post-procedure, or developed a complication within 30-days post-procedure. RESULTS: 217 patients met inclusion criteria (152 P-LB, 65 EUS-LB). American Society of Anesthesiologists (ASA) classification was higher in the EUS-LB group (3 vs. 2, P < 0.001). Non Alcoholic Fatty liver disease was the most common indication for the procedure in both groups. Other baseline variables did not differ significantly in the 2 groups (Table 1). In the EUS-LB group, 28 patients underwent biopsy of a single lobe, while 37 patients underwent biopsy of both right and left lobesTable 1.: Baseline variables – EUS-liver biopsy (EUS-LB) vs. percutaneous liver biopsy (PLB) patientsTable 2.: Comparison of outcomes between EUS guided liver biopsy (EUS-LB) and percutaneous liver biopsy (PLB) patients. The incidence of post-procedure pain and need for analgesics was higher with P-LB compared to EUS-LB, but the differences were not statistically significant (Table 2). There was 1 complication in the EUS-LB (abdominal pain requiring admission) and 1 complication in the P-LB group (gallbladder hematoma). CONCLUSION: Both EUS-LB and P-LB with moderate sedation appear to result in acceptably low rates of post-procedure pain and complications. EUS-LB allows for biopsy of left and right liver lobes without significant increase in pain or complications. P-LB with moderate sedation permits safe discharge from the endoscopy unit within an hour post-procedure.