Initial experience with EUS-guided Tru-cut biopsy of benign liver disease

John DeWitt, Kathleen McGreevy, Oscar Cummings, Stuart Sherman, Julia K. LeBlanc, Lee McHenry, Mohammad Al-Haddad, Naga Chalasani

Research output: Contribution to journalArticle

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Abstract

Background: Histologic biopsy of the liver is often essential for diagnosing hepatic parenchymal disease. Tissue acquisition is traditionally obtained by a surgical, transvascular, or percutaneous route. Objective: To describe our initial experience with EUS-guided Tru-cut biopsy (EUS-TCB) of benign liver disease. Design: A prospective case series. Setting: A tertiary-referral hospital in Indianapolis, Indiana. Patients: Consecutive subjects undergoing EUS with suspected hepatic parenchymal disease. Interventions: EUS-TCB of the liver. Main Outcome Measurements: Liver biopsy specimen yield, diagnosis, and procedural complications. Specimens were routinely stained with hematoxylin and eosin and with special stains for reticulin, iron, and trichome. Each case was reviewed by a single experienced pathologist for the number of portal spaces, total specimen length, and final diagnosis. An adequate specimen was defined as 6 or more complete portal tracts. Results: Between February 2007 and March 2008, 21 consecutive patients (mean age 45 years; 13 women) were evaluated. The most common indications for liver biopsy were suspected nonalcoholic steatohepatitis (n = 9), intrahepatic cholestasis (n = 4), and suspected cirrhosis (n = 3). Transgastric biopsy (median 3 passes, range 1-4) into the left lobe (n = 18) or both the left and caudate lobe (n = 3) yielded a median total specimen length of 9 mm (range 1-23 mm). The median total number of portal tracts in the specimen was 2 complete (range 0-10) plus 3 partial (range 0-8) tracts. Six or more complete portal tracts were present in 6 of 21 (29%). A histologic diagnosis was obtained in 19 of 21 (90%). There were no complications. Limitations: The small sample size and low-risk population. Conclusions: In our initial experience, transgastric EUS-TCB of suspected benign liver disease by using a 19-gauge needle appears safe and feasible. Samples obtained are usually smaller than those traditionally considered adequate for histologic assessment. Further refinement of this technique appears indicated.

Original languageEnglish
Pages (from-to)535-542
Number of pages8
JournalGastrointestinal Endoscopy
Volume69
Issue number3
DOIs
StatePublished - Mar 2009

Fingerprint

Liver Diseases
Biopsy
Liver
Trichomes
Reticulin
Intrahepatic Cholestasis
Hematoxylin
Eosine Yellowish-(YS)
Tertiary Care Centers
Sample Size
Needles
Fibrosis
Coloring Agents
Iron
Population

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

Initial experience with EUS-guided Tru-cut biopsy of benign liver disease. / DeWitt, John; McGreevy, Kathleen; Cummings, Oscar; Sherman, Stuart; LeBlanc, Julia K.; McHenry, Lee; Al-Haddad, Mohammad; Chalasani, Naga.

In: Gastrointestinal Endoscopy, Vol. 69, No. 3, 03.2009, p. 535-542.

Research output: Contribution to journalArticle

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abstract = "Background: Histologic biopsy of the liver is often essential for diagnosing hepatic parenchymal disease. Tissue acquisition is traditionally obtained by a surgical, transvascular, or percutaneous route. Objective: To describe our initial experience with EUS-guided Tru-cut biopsy (EUS-TCB) of benign liver disease. Design: A prospective case series. Setting: A tertiary-referral hospital in Indianapolis, Indiana. Patients: Consecutive subjects undergoing EUS with suspected hepatic parenchymal disease. Interventions: EUS-TCB of the liver. Main Outcome Measurements: Liver biopsy specimen yield, diagnosis, and procedural complications. Specimens were routinely stained with hematoxylin and eosin and with special stains for reticulin, iron, and trichome. Each case was reviewed by a single experienced pathologist for the number of portal spaces, total specimen length, and final diagnosis. An adequate specimen was defined as 6 or more complete portal tracts. Results: Between February 2007 and March 2008, 21 consecutive patients (mean age 45 years; 13 women) were evaluated. The most common indications for liver biopsy were suspected nonalcoholic steatohepatitis (n = 9), intrahepatic cholestasis (n = 4), and suspected cirrhosis (n = 3). Transgastric biopsy (median 3 passes, range 1-4) into the left lobe (n = 18) or both the left and caudate lobe (n = 3) yielded a median total specimen length of 9 mm (range 1-23 mm). The median total number of portal tracts in the specimen was 2 complete (range 0-10) plus 3 partial (range 0-8) tracts. Six or more complete portal tracts were present in 6 of 21 (29{\%}). A histologic diagnosis was obtained in 19 of 21 (90{\%}). There were no complications. Limitations: The small sample size and low-risk population. Conclusions: In our initial experience, transgastric EUS-TCB of suspected benign liver disease by using a 19-gauge needle appears safe and feasible. Samples obtained are usually smaller than those traditionally considered adequate for histologic assessment. Further refinement of this technique appears indicated.",
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