Interventional Endoscopy

25 - Endoscopic Ultrasound-Guided Liver Biopsy Compared to Percutaneous and Transjugular Liver Biopsy: A Tertiary Center Experience

Tuesday, October 9
9:30 AM - 9:40 AM
Location: Terrace Ballroom 4 (level 400)

Category: Interventional Endoscopy
Abdul Hamid El Chafic, MD1, Muhammad F. Mubarak, MD1, Janak Shah, MD1, George Therapondos, MD, MPH1, Ricardo Romero, MD1, Jerry Evans, MD2, Ari Cohen, MD1, Ahmed Alsaiari, MD1, Gretchen Galliano, MD1
1Ochsner Clinic Foundation, New Orleans, LA; 2Ochsner Health System, Kenner, LA

Award: Category Award (Interventional Endoscopy)

Introduction: Endoscopic ultrasound guided fine needle biopsy of the liver (EUS-LB) has emerged as a new technique to obtain liver tissue for the workup of parenchymal liver disease. Recent studies on EUS-LB have shown promising results in terms of tissue adequacy and procedural safety. In this study, we compare the specimen quality, complication rates, and recovery times from patients undergoing EUS-LB versus percutaneous (PC-LB) and transjugular (TJ-LB) routes.

Methods: This is a retrospective study of a prospectively maintained database of patients undergoing EUS-LB between November 2016 and April 2018. The EUS-LB cohort was compared to 20 cases of PC-LB and 20 cases of TJ-LB randomly selected from our pathology database during the same time frame as that of EUS-LB. EUS-LB was performed on patients referred for workup of elevated liver tests if the EUS examination showed no biliary obstruction. EUS-LB was obtained using 19-gauge core biopsy needle (Sharkcore, Medtronic, Acquire; Boston Scientific) via modified one pass, one actuation wet suction technique. PC-LB was performed under US or CT guidance using 16 gauge biopsy needle (Monopty; Bard, Covington, GA). TJ-LB was performed using 19 gauge biopsy needle (Cook).

Results: A total of 52 patients underwent 53 EUS-LB (mean age 53.6 ± 15.0 years; 43.1% males), 20 patients underwent PC-LB (mean age 52.7 ± 15.2 years; 35.0% males), and 20 patients underwent TJ-LB (mean age 56.8 ± 9.3 years; 60.0% males). Significantly fewer needle passes were performed in EUS-LB group (92.5% underwent 1 or 2 passes) and PC-LB group (95% underwent 1 or 2 passes) compared to TJ-LB group (95% underwent 5 or 6 passes); p <0.001. EUS-LB produced more complete portal triads (CPT) than PC-LB (p<0.001) and similar number of CPT to TJ-LB (p =1.0). EUS-LB also produced significantly longer aggregate length (AL) than both PC-LB and TJ-LB (p < 0.05). Post procedural recovery time was significantly less among patients undergoing EUS-LB, compared to PC-LB and TJ-LB (p < 0.05). The rate of complications including pain and minor bleeding was similar across the 3 groups (p=0.39). Table 1.

Discussion: EUS-LB using a 19-gauge core needle produced significantly more CPT and longer AL compared to PC-LB. EUS-LB produced similar number of CPT and longer AL compared to TJ-LB and with significantly fewer needle passes. Patient recovery time following EUS-LB is significantly shorter compared to the other liver biopsy routes.

Results Table 1.

Disclosures:
Abdul Hamid El Chafic: Medtronic – Consultant.
Muhammad Mubarak indicated no relevant financial relationships.
Janak Shah indicated no relevant financial relationships.
George Therapondos: Medtronic – Consultant.
Ricardo Romero indicated no relevant financial relationships.
Jerry Evans indicated no relevant financial relationships.
Ari Cohen indicated no relevant financial relationships.
Ahmed Alsaiari indicated no relevant financial relationships.
Gretchen Galliano: Medtronic – Consultant.

Abdul Hamid El Chafic

Thomas Jefferson University
Philadelphia, Pennsylvania

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