High yield of same-session EUS-guided liver biopsy by 19-gauge FNA needle in patients undergoing EUS to exclude biliary obstruction

Stavros N. Stavropoulos, Gene Y. Im, Zahra Jlayer, Michael D. Harris, Teodor C. Pitea, George K. Turi, Peter F. Malet, David M. Friedel, James H. Grendell

Research output: Contribution to journalArticlepeer-review

95 Scopus citations

Abstract

Background: EUS-guided liver biopsy by Trucut yields variable specimen adequacy at high cost, limiting its utility. A modified EUS-guided technique with reliable adequacy could be a viable alternative to standard techniques in cost-effective clinical settings. Objective: To describe our experience with EUS-guided liver biopsy by 19-gauge FNA, non-Trucut, needle in a cost-effective setting: patients with abnormal liver test results of unclear etiology referred for EUS to exclude biliary obstruction in whom an unrevealing EUS would have prompted a next-step liver biopsy by the referring physician. Design: Prospective case series. Setting: Tertiary-care teaching hospital. Patients: Consecutive patients with abnormal liver tests referred for EUS. Interventions: EUS-guided liver biopsy by 19-gauge FNA needle (non-Trucut). Main Outcome Measurements: Diagnostic yield, specimen adequacy, and complications. An adequate specimen was defined as a length of 15 mm or longer and 6 or more complete portal tracts (CPTs). Results: Between July 2008 and July 2011, 22 of 31 consecutive patients meeting inclusion criteria underwent unrevealing EUS with same-session EUS-guided liver biopsy by 19-gauge FNA needle. A median of 2 FNA passes (range 1-3) yielded a median specimen length of 36.9 mm (range 2-184.6 mm) with a median of 9 CPTs (range 1-73 CPTs). EUS-guided liver biopsies yielded a histologic diagnosis and adequate specimens in 20 of 22 patients (91%). Expanded experience led to improved specimen adequacy. There were no complications. Limitation: Small study size. Conclusions: EUS-guided liver biopsy by using a 19-gauge FNA needle appears to be feasible and safe and provides excellent diagnostic yield and specimen adequacy.

Original languageEnglish
Pages (from-to)310-318
Number of pages9
JournalGastrointestinal Endoscopy
Volume75
Issue number2
DOIs
StatePublished - Feb 2012
Externally publishedYes

Keywords

  • CPT
  • EUS-FNA
  • EUS-guided FNA
  • INR
  • complete portal tract
  • international normalized ratio

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