S1308 Utility of Endo-Hepatology in Assessing Liver Fibrosis in Patients With Chronic Liver Disease: Data From University Hospital in WV

Abstract

Introduction: The clinical utility of EUS and the field of Endo-Hepatology (EH) are expanding. While CT-guided liver biopsy (LB) was once considered the gold standard other modalities such as Transient elastography (TE), EUS-shear wave elastography (EUS-E), and EUS guided liver biopsy (EUS-LB) are becoming more prevalent due to multitude of benefits from cost to patient tolerability and comparable accuracy. We look to add to this growing body of evidence. Our study investigated the accuracy and diagnostic yield of EUS-LB. We then compared LB to TE and EUS-E. Our results add to the clinical utility and strengths of EH. Methods: In this IRB approved retrospective analysis, 53 patients with chronic liver disease (CLD) were diagnosed with severe fibrosis on TE and underwent EUS guided analysis. EGD indicated for distinct reasons was coupled with EUS-LB to further stage the fibrosis of these high-risk patients. The study evaluated patients between October 2021 – June 2022. Demographic characteristics were collected in each patient. Liver biopsies were reviewed for adequacy. A cutoff of 10 and 14 kPa on TE/EUS-E was used to assess accuracy in predicting fibrosis when compared to EUS-LB. Correction coefficient was used to assess the association between these methods. Results: Our Appalachian population was unique, as it was predominantly Caucasian, held a BMI >30, and multiple comorbidities equally present in both genders. Our study found a correlation between the EUS-E and TE in KPa (r=0.549, p=0.1) as well as EUS-E KPa and LB fibrosis stage (r=0.6627, p=0.007) as showed in Fig 2. Additionally, a significant correlation was found between the TE and LB in terms of fibrosis stage (r=0.6 p=0.003) and steatosis stage (r=0.5249, p=0.01) in diagnosis of cirrhosis (Table A). This was more consistent in ALD (r=0.5847) in comparison to NAFLD (r=0.4). Interestingly, this correlation seems more consistent in higher fibrosis stages as shown in Table B. Conclusion: 53 patients underwent EH based procedures without any complications. EUS-LB had adequacy rate of 92.2% and held > 14 portal triads on avg. Our study indicated that various modalities via EH are reliable in identifying severe fibrosis when compared to the previous gold standard and TE. Our study adds to the large body of evidence regarding reliability of TE in detecting severe fibrosis present in various etiologies of CLD.Figure 1.: Statistical Analysis: Figures and Tables Table 1. - Demographics Result of This Study Population Total number of cases, n 53 Age, mean ± SD 55.6 ± 12.9 Male, n (%) 26 (49.1%) Female, n (%) 27 (50.9%) Race White, n (%) 52 (98.1%) Black, n (%) 1 (1.9%) BMI, mean ± SD 33.3 ± 9.2 Etiology of Liver Disease Non-alcoholic fatty liver disease (NAFLD), n (%) 14 (26.4%) Viral Hepatitis, n (%) 8 (15.1%) Alcohol, n (%) 34 (62.2%) Other (AIH, DILI, PBC), n (%) 10 (18.9%) Clinical Cirrhosis, n (%) 20 (37.7%) EV/GV on EGD, n (%) 15 (28.3%) Fibroscan, Mean ± SD in kPa 23.9 ± 19.2 EUS-SWE, Mean ± SD in kPa 24.3 ± 8.1 Fibrosis stage ³ 3 on biopsy, n (%) 25 (54.3%) Portal Triad on biopsy, mean ± SD 14 ± 5.6