EUS-guided Liver Research Articles

Su1391 COMPARISON OF THE DIAGNOSTIC YEILD AND SAFETY OF 1ST GENERATION EUS CORE BIOPSY NEEDLES WITH FINE NEEDLE ASPIRATION AND NEXT GENERATION EUS CORE BIOPSY NEEDLES- A SYSTEMATIC REVIEW

EUS-guided liver biopsy for the diagnosis of parenchymal liver diseases is being considered as an alternative to percutaneous method of liver biopsy. Several studies have evaluated the diagnostic yield from EUSLB with varying results. Different needle types have been used in the studies published to date. It is unknown if the discrepancy in the diagnostic yield is due to the various needle designs. We performed this meta-analysis to evaluate the diagnostic yield from different needle designs of similar gauge (19G only). We searched several electronic databases for all the studies evaluating the diagnostic yield of EUSLB for parenchymal liver diseases using 19G EUS-fine needle aspiration (FNA) or fine needle biopsy (FNB) needle (Procore and Shark Core needles). Studies were excluded if EUS FNA or FNB needle other than 19G was used, animal or ex-vivo models, biopsy for focal liver lesions, small case-series (<10). Measured outcomes included number of complete portal triads (CPT) which were pooled as weighted means. These were analyzed using random effects model. Heterogeneity was explored with meta-regression based on total specimen length (TSL). Weighted mean difference (WMD) were calculated to compare all three needles. A total of 9 studies with 394 patients (FNA needle (Boston-Scientific, Natick, Mass) in 78 patients, Procore needle (Cook Medical Inc, Winston-Salem, NC) in 127 patients and Shark Core needle (Medtronic, Sunnyvale, CA) in 189 patients, were included in this systematic review and meta-analysis. Weighted pooled mean with 95% confidence interval (CI) for Procore needle was 6.38 (3.92, 8.83), Cochran Q test P < 0.001, I2= 90%. Meta-regression analysis was conducted to explore heterogeneity. TSL was found to be a significant predictor of heterogeneity (intercept -0.05; TSL coefficient 0.36; P < 0.001) and R2 was 0.95. Therefore, longer specimen length resulted in higher number of complete portal tracts and completely explained heterogeneity across studies. Weighted pooled mean for Shark Core needle and FNA needle were 27.71 (8.27, 47.15), Cochran Q test P<0.001, I2=92% and 13.77 (4.18, 22.78), Cochran Q test P < 0.001, I2 =90%, respectively. Due to paucity of number of studies, meta-regression was not conducted for these analyses. WMD comparing Shark Core and Procore needles was 21.33 (-2.32, 44.99) (P=0.06). For the comparison between FNA and Procore needles WMD was 7.41 (-0.26, 15.10), (P=0.06). Finally, WMD for comparison of Shark Core with FNA was 13.91 (-16.92, 44.75) (P=0.37). Both Shark Core needle and FNA needle showed a trend towards obtaining higher complete portal tracts as compared to Procore needles. Further prospective studies comparing these needles are required at this time to identify optimal needle for EUS guided liver biopsy.Fig A: Forest plot showing complete portal tracts obtained by Shark Core needleFig. B: Forest plot showing complete portal tracts obtained by FNA needleView Large Image Figure ViewerDownload Hi-res image Download (PPT)

Mo1351 THE SAFETY AND FEASIBILITY OF ENDOSCOPIC ULTRASOUND-GUIDED PARENCHYMAL LIVER BIOPSY AT A LARGE COMMUNITY HOSPITAL

Parenchymal liver biopsy is important for diagnosis and management for many liver disease patients. Percutaneous image-guided liver biopsy is currently the most widely used method; however, endoscopic ultrasound (EUS)-guided liver biopsy with newer flexible large-bore core needles represents an emerging approach for sampling. EUS-guided liver biopsy (EUS-LB) offers certain advantages over traditional methods such as doppler assistance to avoid intervening vessels and the ability to image both hepatic lobes to minimize sampling error. Our aim is to evaluate the feasibility and safety of EUS-LB in obtaining adequate tissue samples for diagnosis of unexplained liver disease and to compare our results to percutaneous liver biopsy at our institution. We conducted a retrospective chart review of patients who underwent EUS-LB at Santa Clara Valley Medical Center in San Jose, California between January 1 and October 30, 2017. All patients who underwent EUS-LB had 2 passes taken. For comparative purposes, we also identified patients who underwent a percutaneous liver biopsy for similar indications. We collected data on procedure duration, adverse events, complete portal tracts (CPTs), inflammation grade, and fibrosis grade. To date, there have been 10 patients who have undergone EUS-LB with a 19-gauge Acquire needle (Boston Scientific) at our institution. The indications for EUS-LB included unexplained abnormal LFTs (n=8), staging of hepatitis B (n=1), and cirrhosis of unclear etiology (n=1). The average procedure duration for EUS-LB and percutaneous liver biopsy was 19 minutes and 28 minutes, respectively. The average number of CPTs was 9.8 (range 6-13) and 9.6 (range 6-14), respectively. More than two-thirds of patients in the EUS-LB group were determined to have mild inflammation (7/10, 70%). Most patients had 0 stage of fibrosis (8/10, 80%). Recovery time for EUS-LB patients averaged 29 minutes while percutaneous liver biopsy patients were all placed under observation for 240 minutes prior to discharge. No patients experienced any adverse events. EUS-LB is feasible, safe, and produces a comparable sample adequacy for histologic examination compared to percutaneous liver biopsy at our community hospital. In addition, EUS-LB requires less time to complete, both in procedure time and recovery time. Further study regarding EUS-LB is warranted for optimal technique (e.g. the use and amount of suction) as well as direct comparison to percutaneous approach in terms of possible cost reduction and improved patient satisfaction.

Su1388 IS EUS GUIDED LIVER BIOPSY READY FOR PRIME TIME? YES

Conventionally, liver biopsies have been performed via percutaneous and transjugular routes. Recently, endoscopic ultrasound (EUS) has been utilized to obtain core liver biopsies with varying success. One of the advantages of EUS-guided liver biopsy sampling (EUS-LB) is the ability to quickly and safely obtain liver passes from both lobes, thus minimize sampling error. Few studies have compared these methods of liver biopsies and have reached conflicting conclusions. We conducted a systematic review and meta-analysis to compare efficacy of EUS guided liver biopsies with both percutaneous and transjugular liver biopsies. We searched Medline, Embase, Scopus and Web of Science databases from January 2008 through November 11, 2017 to identify studies comparing EUS guided liver biopsy yield with percutaneous or transjugular methods. We also searched abstracts of Digestive Disease Week from 2008 to 2017 to increase our search yield. Main out of interest was mean number of complete portal triads. Mean differences (MD) between the three modalities were calculated and pooled using fixed effect model. Quality assessment was conducted using Newcastle Ottawa Scale (NOS). We included a total of 4 observational studies with 347 patients in this systematic review and meta-analysis. Among them, 184 underwent EUS guided biopsy, 104 got percutaneous and remaining 59 underwent transjugular biopsy. One study was rated as high quality while remaining 3 studies were rated as moderate quality as per NOS assessment. All transjugular biopsies were performed with 21 G needle, percutaneous biopsies were performed with 18 G needles, while EUS guided biopsies could be performed with Shark Core needle 19G, FNA needle 19G or Procore needle 19G. Mean number of passes required by EUS was 2.6±1.1. Pooled MD with 95% confidence interval (CI) while comparing EUS with percutaneous biopsy was -1.65 (-3.03, -0.26), I2=0% in favor of EUS. Pooled MD while comparing EUS with transjugular biopsy was -4.05 (-7.82, -0.27) in favor of EUS with no heterogeneity. There was no bleeding reported in any of the 184 patients who underwent EUS guided liver biopsies. EUS guided liver biopsy is superior to the conventional percutaneous and transjugular biopsies and may become the diagnostic method of choice when biopsy is required. No adverse events related to bleeding or pain were reported in the EUS group.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Mo1280 EUS-GUIDED PORTAL PRESSURE GRADIENT MEASUREMENT CAN BE SAFELY COMBINED WITH LIVER BIOPSY DURING A SINGLE ENDOSCOPIC PROCEDURE

Measuring the portal pressure gradient can assist in the management of patients with suspected or known liver disease. Understanding a patient’s portal pressure gradient can help predict complications such as: variceal bleeding, ascites, encephalopathy, and perioperative mortality. Traditionally, interventional radiologists have measured the portal pressure gradient during a transjugular liver biopsy. EUS-guided liver biopsy has been proven to be an effective and safe alternative to percutaneous transhepatic and transjugular liver biopsy. A novel endoscopic device allows for EUS-guided portal pressure gradient measurement (EUS-PPGM). To assess the safety of combining EUS-PPGM and liver biopsy during a single endoscopic procedure. EUS-PPGM with liver biopsy was performed on 38 patients at our institution between June 2014 and May 2017. All procedures were performed by one of two experienced endoscopists (JS and KC). Pre-procedural data collected included: etiology of cirrhosis, liver function testing, and complications of cirrhosis (e.g., varices, ascites, encephalopathy). During the procedure, portal pressure gradients and biopsy specimen data was collected. Post-procedure, all patients were monitored for complications including pain, nausea, vomiting, bleeding, infection, or admission to hospital. There were 38 patients included in the analysis. A satisfactory portal pressure gradient measurement and liver biopsy specimen was achieved during every procedure. There were 35 patients (92%) who were Child-Pugh class A, while the remaining 3 patients (8%) were Child-Pugh class B. On average, the platelet count was 165 (range 88-377) and INR was 1.1 (range 0.9-1.6). The average gradient was 7.3 mmHg (range 0 – 27.3mmHg). While 18 patients (47%) had evidence of portal hypertension (gradient >5mmHg) only 12 patients (32%) had clinically significant portal hypertension (gradient ≥10). There were no serious complications from any procedures. 2 patients (5%) developed pain and nausea that were managed using oral pain medication and anti-emetics. No patients developed signs bleeding or infection. No patients required admission to hospital as a result of the procedure. EUS-PPGM combined with liver biopsy in a single endoscopic procedure may be safely performed in patients with Child-Pugh A and B cirrhosis. This combined procedure offers a novel substitute to transjugular liver biopsies with portal pressure gradient measurement.

Role of EUS-guided liver biopsy in benign parenchymal disease (with video).

Role of EUS-guided liver biopsy in benign parenchymal disease (with video).

Diagnostic Yield of Novel EUS-Guided Liver Biopsy Needles in an Ex vivo Model

Introduction: There is growing interest and efficacy testing in EUS-guided liver biopsy as an alternative to the percutaneous or transjugular approach. We aimed to test the diagnostic yield of novel 19G and 22G FNB needles to existing EUS needles in an ex vivo liver model. This is the first study to evaluate the histologic yield of the Acquire 22G EUS-FNB (Boston Scientific) and EZ Shot 3Plus 19G/22G needles (Olympus). Methods: We evaluated the Acquire 22G, SharkCore 19G/22G (Medtronic), EZ Shot 3Plus 19G/22G and EchoTip ProCore 20G (Cook) needles. Using an ex vivo cow liver model, each needle was passed through an Olympus echoendoscope to obtain a fine-needle aspirate or core biopsy. A flexed scope position was used to approximate in vivo tissue acquisition. Each needle underwent 10 passes, alternating between a slow pull of the stylet and 10mL suction on a syringe. 5 actuations per needle puncture were performed, with 4cm needle advancement per actuation. Primary outcome was the number of portal tracts obtained per needle aspirate. Secondary outcome was total linear specimen length. Pairwise comparisons between needle types and ‘slow-pull' vs. syringe suction techniques were performed using t-tests (p < 0.05 significance). Results: The mean number of portal tracts obtained per needle aspirate for each needle type was: SharkCore 19G (2.45+/-1.00), SharkCore 22G (1.10+/-0.55), Acquire 22G (1.70+/-0.80), EZ Shot 3Plus 19G (1.25+/-0.39), EZ Shot 3Plus 22G (0+/-0) and EchoTip ProCore 20G (1.30+/-0.51). The Shark-Core 19G yielded a significantly increased mean number of portal tracts compared with all needle types, with the exception of the Acquire 22G (Table 1). Among 22G needles, the Acquire 22G yielded the highest number of portal tracts (Table 1). The Acquire 22G portal tract yield was not statistically different from the SharkCore 19G (p=0.17) and EZ Shot 3Plus 19G (p=0.17). There was no statistical difference in tissue length between slow-pull and suction methods; however, the slow-pull method yielded a significant increase in portal tracts in Acquire 22G (p=0.02) and SharkCore 22G (p=0.03) needles.Table: Table. Comparison of Portal Tract Yield Amongst Needle TypesConclusion: Compared to other 19G and 20G EUS core needles, the SharkCore 19G EUS-FNB needle yielded the highest number of portal tracts. Among the 22G needles, the novel Acquire 22G EUS-FNB needle yielded the highest number of portal tracts. The Acquire 22G was not statistically different from the SharkCore 19G and EZ Shot 3Plus 19G with regards to portal tract yield.

Comparison of the Diagnostic Yield of EUS Needles for Liver Biopsy: Ex Vivo Study.

Background and Aims EUS-guided liver biopsy is an emerging method of liver tissue acquisition which is safe and had been shown to produce excellent histological yield. There is limited data comparing the diagnostic yield of different FNA needles. We aimed to compare the diagnostic performance of four commercially available 19-gauge FNA needles. Methods Four FNA needles and one percutaneous needle were used to perform liver biopsies on two human cadaveric livers: Cook Echotip Procore™, Olympus EZ Shot 2™, Boston Scientific Expect Slimline™, Covidien SharkCore™, and an 18-gauge percutaneous needle (TruCore™, Argon Medical Devices). Each needle obtained biopsies by three, six, and nine complete back-and-forth motions of the needle (“throw”) with a fanning technique. The combined lengths of specimen fragments and the total number of complete portal tracts (CPT) were measured by a blinded pathologist. One-way analysis of variance (ANOVA) and Bonferroni correction were used for statistical analysis. Results A total of 52 liver biopsies were performed. The Covidien SharkCore needle had significantly greater number of CPT compared to other FNA needles. The number of “throws” did not impact the number of CPT significantly. There was no statistically significant difference in mean total specimen length between each FNA needle type. Conclusion The Covidien SharkCore needle produced superior histological specimen by capturing more CPT, possibly due to its unique needle design.

Mo1287 Comparison of Eus-Guided Liver Abscess Drainage and Percutaneous Drainage for the Treatment of Liver Abscess

Background and aims :percutaneous drainage(PCD)is now the first-line drainage method for liver abcess because of its minimal invasiveness and high technical success rate. However,this procedure has several disadvantages,such as extra-drainage and self-tube removal. Recentry,EUS-guided liver abcess drainage (EUS-AD)has been developed. However,only a few reports of EUS-AD have been reported in addition the clinical benefits of PCD and EUS-AD have not been reported. In the present study,the safety and feasibility of EUS-AD using fully covered SEMSs (FCSEMSs) and the outcomes of EUS-AD and PCD were examined retrospecitively.

Optimizing EUS-guided liver biopsy sampling: comprehensive assessment of needle types and tissue acquisition techniques

EUS-guided liver biopsy sampling using FNA and, more recently, fine-needle biopsy (FNB) needles has been reported with discrepant diagnostic accuracy, in part due to differences in methodology. We aimed to compare liver histologic yields of 4 EUS-based needles and 2 percutaneous needles to identify optimal number of needle passes and suction. Six needle types were tested on human cadaveric tissue: one 19G FNA needle, one existing 19G FNB needle, one novel 19G FNB needle, one 22G FNB needle, and two 18G percutaneous needles (18G1 and 18G2). Two needle excursion patterns (1 vs 3 fanning passes) were performed on all EUS needles. Primary outcome was number of portal tracts. Secondary outcomes were degree of fragmentation and specimen adequacy. Pairwise comparisons were performed using t tests, with a 2-sided P< .05 considered to be significant. Multivariable regression analysis was performed. In total, 288 liver biopsy samplings (48 per needle type) were performed. The novel 19G FNB needle had significantly increased mean portal tracts compared with all needle types. The 22G FNB needle had significantly increased portal tracts compared with the 18G1 needle (3.8 vs 2.5, P< .001) and was not statistically different from the 18G2 needle (3.8 vs 3.5, P= .68). FNB needles (P< .001) and 3 fanning passes (P≤ .001) were independent predictors of the number of portal tracts. A novel 19G EUS-guided liver biopsy needle provides superior histologic yield compared with 18G percutaneous needles and existing 19G FNA and core needles. Moreover, the 22G FNB needle may be adequate for liver biopsy sampling. Investigations are underway to determine whether these results can be replicated in a clinical setting.

Su1984 A Novel EUS-guided Liver Biopsy Needle is Superior to Gold Standard Percutaneous Needle: Examining the Effect of Needle Design and Number of Excursions on Histologic Yield

Su1984 A Novel EUS-guided Liver Biopsy Needle is Superior to Gold Standard Percutaneous Needle: Examining the Effect of Needle Design and Number of Excursions on Histologic Yield

Su1983 Safety and Feasibility of Combination EUS-Guided Portal Pressure Gradient Measurement and Liver Biopsy: The Realization of Endo-Hepatology

Liver biopsy and portal pressure gradient (PPG) measurement are important procedures for the diagnosis and management of patients with liver disease. While liver biopsy is usually performed percutaneously, PPG is indirectly measured via a transjugular approach. EUS-guided liver biopsy is a possible alternative to percutaneous liver biopsy. Recently, we have shown in both animal and human studies that EUS-guided PPG measurement is a potential alternative to the transjugular approach.

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

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.

EUS-guided liver biopsy provides diagnostic samples comparable with those via the percutaneous or transjugular route

Liver biopsy (LB) traditionally has been performed via a percutaneous (PC), transjugular (TJ), or surgical approach. EUS-guided LB (EUS-LB) is an emerging method that has shown promise in terms of tissue yield and procedural safety. Comparison of histologic yield of EUS-LB with other methods of LB has not been done. This study aimed to compare tissue yield of different LB methods. EUS-LB, TJ-LB, and PC-LB were identified retrospectively. EUS-LB was obtained via transgastric and transduodenal biopsy, or via transgastric (left lobe) biopsy alone using a 19-gauge FNA needle (non-Trucut). TJ-LB specimens were obtained with an 18- or 19-gauge needle, and PC-LB specimens with an 18- or 20-gauge needle. Stained slides were digitized on a whole slide scanner, and the total specimen length (TSL) and the count of complete portal triads (CPTs) were determined. Comparisons of TSL and CPT among the 3 groups were done with Wilcoxon rank sum tests. Wilcoxon rank sum tests indicated that EUS-LB of both liver regions produced significantly more tissue in terms of both TSL and CPTs compared with a PC-LB (P = .0000 and .0006). EUS-LB produced significantly longer TSL than TJ-LB (P = .01) and similar CPTs (P = .22). Those EUS-LB cases in which the left lobe only was sampled were not statistically different compared with PC-LB and TJ-LB. EUS-guided-LB produces specimens at least comparable to, and in some cases better than, PC-LB or TJ-LB. Widely separated liver regions can be easily sampled, which may have some benefit. The role of EUS-LB is likely to increase in the future.

EUS-guided liver biopsy for parenchymal disease: a comparison of diagnostic yield between two core biopsy needles

EUS-guided biopsy of the liver has a variable diagnostic accuracy and specimen adequacy. A new core biopsy needle has been developed that may improve performance. The objective of this study was to compare the diagnostic yield of a new core biopsy needle with the previous standard needle. In this cross-sectional study, consecutive patients who underwent EUS-guided core liver biopsy over a 7-year period for suspected parenchymal disease were prospectively evaluated. Between 2007 and 2011, all biopsies were performed with a 19-gauge Tru-cut biopsy needle (Quick-core [QC]), whereas a novel reverse bevel needle (PC) was used exclusively from 2011 to 2014. All specimens were examined by 1 of 3 experienced, blinded pathologists for the following: presence of visible core, aggregate specimen length, number of complete portal tracts, and specimen adequacy. A total of 75 patients (mean age 51 years, 51 female) underwent liver biopsy by using the QC (n = 45) or PC (n = 30) needle. The QC and PC groups had similar demographics, indications for EUS, indications for liver biopsy, and liver findings on EUS. Compared with those of the QC, biopsies with the PC required fewer passes (median 2 vs 3; P < .0001) but produced longer aggregate length (median 20 mm vs 9 mm; P < .0001) with more complete portal tracts (median 5 vs 2; P = .0003) and adequate specimens (P < .01). Two patients had abdominal pain after liver biopsy with the QC needle. Compared with the QC needle, EUS-guided core liver biopsy with the PC needle produced longer aggregate length, more complete portal tracts, and more adequate specimens despite fewer passes (Clinical trial registration number: NCT00586313.).

Clinical Outcome of Endoscopic Ultrasound-Guided Liver Abscess Drainage Using Self-Expandable Covered Metallic Stent (with Video).

Percutaneous drainage (PCD) is now the first-line drainage method for liver abscess because of its minimal invasiveness and high technical success rate. However, this procedure has several disadvantages, such as extra-drainage and self-tube removal. Recently, EUS-guided liver abscess drainage (EUS-AD) has been developed. However, only a few reports of EUS-AD have been reported. In addition, the clinical benefits of PCD and EUS-AD have not been reported. In the present study, the safety and feasibility of EUS-AD using fully covered SEMS (FCSEMS) and the clinical outcomes of EUS-AD and PCD were examined retrospectively. Twenty-seven consecutive patients who underwent PCD or EUS-AD between April 2012 and April 2015 were included in this study. EUS-AD was performed using FCSEMS. In addition, to prevent stent migration, 7-Fr pig tail plastic stent was placed within FCSEMS. Technical success was achieved in all patients of both groups. Clinical success was 100 % in the EUS-AD group although it was 89 % in PCD group (P = 034). Three adverse events were seen in the PCD group (self-tube removal n = 1, tube migration n = 2), but no adverse events were seen in the EUS-AD group. The median hospital stay was significantly shorter in the EUS-AD group than in the PCD group (21 vs 41 days, P = 0.03). Because of the short hospital stay, the high clinical success rate, and the low adverse event rate compared to PCD, EUS-AD has potential as a first-line treatment for liver abscess.

935 A Novel EUS-Guided Liver Biopsy Needle Is Superior to 19-G Core and FNA Needles: Examining the Effect of Needle Design, Number of Excursions, and Variable Suction Parameters on Histologic Yield

935 A Novel EUS-Guided Liver Biopsy Needle Is Superior to 19-G Core and FNA Needles: Examining the Effect of Needle Design, Number of Excursions, and Variable Suction Parameters on Histologic Yield

Improvements and innovations in endoscopic ultrasound guided fine needle aspiration.

Keywords: Algorithm; Core histology needle; Cytology; Endoscopic ultrasound guided fine needle aspiration fine needle biopsy; Histology

Mo1388 Endoscopic Ultrasonography-Guided Drainage of Hepatic Abscesses by Using Self-Expandable Metal Stents (SEMS)

Conventional therapies of hepatic abscesses are surgical or percutaneous drainage. However, both procedures have been reported on high morbi-mortality rates. Recently, scattered cases of EUS-guided liver abscesses drainage have been reported by means of plastic stents or nasocystic catheters. Covered SEMS ( cSEMS) provide a larger diameter fistula than plastic stents, and therefore may allow for faster drainage and shorter time to resolution of fluid collections. There are no published experience about, so, we aimed to evaluate the technical feasibility, safety and efficacy of SEMS for treating hepatic abscesses in a consecutive case series of four patients.

Endoscopic Ultrasound-guided Liver Biopsy in a Pediatric Patient

Purpose: A 9-year-old female was referred due to crampy, diffuse abdominal pain and diarrhea for 6 months. She had four bowel movements a day associated with urgency and rectal bleeding. The patient denied any recent viral like illness, rash, fevers, jaundice, or joint pains. No family history of any IBD or liver disease. No recent travel. She had tried omeprazole but this did not relieve her symptoms. Her vitals including her weight was stable. Her BMI was 17. She had no icterus. Her abdomen was soft, flat, nondistended, liver was 2 cm below the right costal margin, no splenomegaly, no ascites, and she had normal bowel sounds. She had no perianal lesions and no rashes. On review of her labs, her Hb was 11 mg/dL with evidence of an iron deficiency anemia. Her AST was 216 U/L, ALT 289 U/L, Alk Phos 258 U/L, total bilrubin of 0.3 mg/dL, and an albumin of 4.0 g/dl. An extensive laboratory work up for her elevated liver enzymes was unrevealing, including acute hepatitis panel, ANA, anti-smooth muscle antibody, ceruloplasmin, alpha one antitrypsin, tissue transglutaminase, PT/INR, CRP, and TSH. An abdominal ultrasound revealed a normal appearing liver and gallbladder without intrahepatic ductal dilation. A colonoscopy revealed continuous inflammation from the rectum to the ascending colon consistent with ulcerative colitis. She was referred to our adult gastroenterology clinic for EUS-guided liver biopsy. We performed a core biopsy with a 19 gauge ultrasound biopsy needle (EchoTip ProCore; Cook Medical Inc., Bloomington, IN) with a transgastric approach of the left lobe of the liver and a transduodenal approach of the right lobe. The pathology revealed portal inflammation with edema and bile ductular reaction most likely due to downstream biliary obstruction. She had no procedural complications. We present this case to showcase the use of EUS-guided liver biopsy in pediatric patients. This technique has been shown in the past to be an effective and safe technique in adult patients.

Endoscopic ultrasound-guided hepatic and perihepatic abscess drainage: an evolving technique

Interventional radiology-guided percutaneous drainage of liver abscesses with concomitant use of antibiotics has been the conventional approach for the treatment of liver abscesses. Hepatic abscesses refractory or not amenable to percutaneous drainage have been treated with surgical drainage, either via laparoscopic or open laparotomy techniques. The aim of this review was to evaluate the technical feasibility and efficacy of endoscopic ultrasound (EUS)-guided drainage of liver abscesses. A literature review was performed to identify the studies describing the technique. In this review article we have summarized case series or reports describing EUS-guided liver abscess drainage. The indications, techniques, endoprostheses, limitations and complications reported are discussed. A total of seven cases have been described so far in the literature which included patients with failed conventional treatment modalities. The EUS-guided drainage technique involves puncturing the abscess using endosonography to gain access, passing a guidewire followed by tract dilation and placement of an endoprosthesis for drainage. Studies have reported 100% technical and clinical success rates in selected cases. No complications were reported. EUS-guided drainage of liver abscesses can be a safe and effective alternative approach in the management of liver abscesses in selected patients.