Skip to main content
SpringerLink
Log in

The Role of EUS in Liver Biopsy

  • Pancreas and Biliary Tract (O Haluszka, Section Editor)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

EUS-guided liver biopsy (EUS-LB) is being used with increased frequency to perform parenchymal liver biopsy. Evolution of the technique can now achieve excellent liver tissue cores. This review covers important developments in this procedure.

Recent Findings

Clinical studies have recently demonstrated that the 19G EUS core biopsy needle is superior to non-core needles for liver tissue acquisition. In addition, wet suction provides more robust tissue samples than dry suction. Heparin priming of the needle (instead of saline) can prevent blood clogging within the needle lumen. A 1-hour recovery time after the EUS-LB is sufficient in almost all cases. The EUS-LB can deliver bilobar biopsies, which can decrease sampling error. Patients who need a liver biopsy in addition to an endoscopy or EUS are best served by the EUS-LB, as the combination procedure saves time and cost.

Summary

The EUS-LB is a safe and effective means for procuring good liver core biopsies. Incremental improvements in technique have increased quality of the resulting specimen. Future directions of this technique are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

EUS:

Endoscopic ultrasound

EUS-LB:

Endoscopic ultrasound–guided liver biopsy

FNA:

Fine needle aspiration

FNB:

Fine needle biopsy

G:

Gauge

LB:

Liver biopsy

NAFLD:

Non-alcoholic fatty liver disease

U/S:

Ultrasound

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Caldwell S. Liver biopsy: the reports of its demise are greatly exaggerated. Clin Transl Gastroenterol. 2016;7(5):e171. https://doi.org/10.1038/ctg.2016.30.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Dewitt J, McGreevy K, Cummings O, et al. Initial experience with EUS-guided Tru-cut biopsy of benign liver disease. Gastrointest Endosc. 2009;69(3 Pt 1):535–42. https://doi.org/10.1016/j.gie.2008.09.056.

    Article  PubMed  Google Scholar 

  3. •• Pineda JJ, Diehl DL, Miao CL, et al. EUS-guided liver biopsy provides diagnostic samples comparable with those via the percutaneous or transjugular route. Gastrointest Endosc. 2016;83(2):360–5. https://doi.org/10.1016/j.gie.2015.08.025 Comparison of EUS-LB to other methods of LB (transvenous and percutaneous), demonstrating equivalence.

    Article  PubMed  Google Scholar 

  4. • Tapper EB, Lok ASF. Use of liver imaging and biopsy in clinical practice. N Engl J Med. 2017;377:756–68. https://doi.org/10.1056/NEJMra1610570 Recent review of use of liver biopsy as well as non-invasive imaging in clinical practice.

    Article  PubMed  Google Scholar 

  5. Garcia-Tsao G, Boyer JL. Outpatient liver biopsy: how safe is it? Ann Intern Med. 1993;118(2):150–3. https://doi.org/10.7326/0003-4819-118-2-199301150-00013.

    Article  CAS  PubMed  Google Scholar 

  6. Rösch J, Hanafee WN, Snow H. Transjugular portal venography and radiologic portacaval shunt: an experimental study. Radiology. 1969;92:1112–4. https://doi.org/10.1148/92.5.1112.

    Article  PubMed  Google Scholar 

  7. Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med. 2004;344:495–500.

    Article  Google Scholar 

  8. Cholongitas E, Senzolo M, Standish R, Marelli L, Quaglia A, Patch D, et al. A systematic review of the quality of liver biopsy specimens. Am J Clin Pathol. 2006;125(5):710–21. https://doi.org/10.1309/W3XC-NT4H-KFBN-2G0B.

    Article  PubMed  Google Scholar 

  9. Kalambokis G, Manousou P, Vibhakorn S, Marelli L, Cholongitas E, Senzolo M, et al. Transjugular liver biopsy - indications, adequacy, quality of specimens, and complications - a systematic review. J Hepatol. 2007;47(2):284–94. https://doi.org/10.1016/j.jhep.2007.05.001.

    Article  PubMed  Google Scholar 

  10. •• Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD. AASLD position paper liver biopsy. Hepatology. 2009. https://doi.org/10.1002/hep.22742 Comprehensive review of liver biopsy including indication, technical aspects, and histology analysis.

  11. Mathew A. EUS-guided routine liver biopsy in selected patients [7]. Am J Gastroenterol. 2007;102(10):2354–5. https://doi.org/10.1111/j.1572-0241.2007.01353_7.x.

    Article  PubMed  Google Scholar 

  12. Gleeson FC, Clayton AC, Zhang L, Clain JE, Gores GJ, Rajan E, et al. Adequacy of endoscopic ultrasound core needle biopsy specimen of nonmalignant hepatic parenchymal disease. Clin Gastroenterol Hepatol. 2008;6(12):1437–40. https://doi.org/10.1016/j.cgh.2008.07.015.

    Article  PubMed  Google Scholar 

  13. Sey MSL, Al-Haddad M, Imperiale TF, McGreevy K, Lin J, Dewitt JM. EUS-guided liver biopsy for parenchymal disease: a comparison of diagnostic yield between two core biopsy needles. Gastrointest Endosc. 2016;83(2):347–52. https://doi.org/10.1016/j.gie.2015.08.012.

    Article  PubMed  Google Scholar 

  14. • Stavropoulos SN, Im GY, Jlayer Z, et al. High yield of same-session EUS-guided liver biopsy by 19-gauge FNA needle in patients undergoing EUS to exclude biliary obstruction. Gastrointest Endosc. 2012;75(2):310–8. https://doi.org/10.1016/j.gie.2011.09.043 Seminal paper demonstrating that a regular 19G EUS needle could be used to proceure adequate liver biopsy.

    Article  PubMed  Google Scholar 

  15. Diehl D, Johal A, Khara H, Stavropoulos S, al-Haddad M, Ramesh J, et al. Endoscopic ultrasound-guided liver biopsy: a multicenter experience. Endosc Int Open. 2015;3(03):E210–5. https://doi.org/10.1055/s-0034-1391412.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Schulman AR, Thompson CC, Odze R, Chan WW, Ryou M. Optimizing EUS-guided liver biopsy sampling: comprehensive assessment of needle types and tissue acquisition techniques. Gastrointest Endosc. 2017;85(2):419–26. https://doi.org/10.1016/j.gie.2016.07.065.

    Article  PubMed  Google Scholar 

  17. Mok SR, Diehl DL, Johal AS, Khara HS, Diehl M, Mudireddy PR, et al. Mo1245 19 versus 22 gauge fine needle biopsy for endoscopic ultrasound guided liver biopsy (EUS-LB): a prospective randomized trial. Gastrointest Endosc. 2017;85(5):AB473–4. https://doi.org/10.1016/j.gie.2017.03.1553.

    Article  Google Scholar 

  18. Attam R, Arain MA, Bloechl SJ, Trikudanathan G, Munigala S, Bakman Y, et al. “Wet suction technique (WEST)”: a novel way to enhance the quality of EUS-FNA aspirate. Results of a prospective, single-blind, randomized, controlled trial using a 22-gauge needle for EUS-FNA of solid lesions. Gastrointest Endosc. 2015;81(6):1401–7. https://doi.org/10.1016/j.gie.2014.11.023.

    Article  PubMed  Google Scholar 

  19. • Mok SRS, Diehl DL, Johal AS, et al. A prospective pilot comparison of wet and dry heparinized suction for EUS-guided liver biopsy (with videos). Gastrointest Endosc. 2018. https://doi.org/10.1016/j.gie.2018.07.036 Study demonstrating significant advantage of wet suction for EUS-LB.

  20. Diehl D, Mok S, Khara H, Johal A, Kirchner H, Lin F. Heparin priming of EUS-FNA needles does not adversely affect tissue cytology or immunohistochemical staining. Endosc Int Open. 2018;06(03):E356–62. https://doi.org/10.1055/s-0043-121880.15.

    Article  Google Scholar 

  21. Ching Companioni RA, Johal AS, Confer B, Khara HS, Diehl DL. Mo1349 a prospective randomized trial of 19-gauge (G) aspiration needle versus 19G core biopsy needle for endoscopic ultrasound-guided liver biopsy. Gastrointest Endosc. 2018;87(6):AB457–8. https://doi.org/10.1016/j.gie.2018.04.1999.

    Article  Google Scholar 

  22. Ching Companioni R, Johal AS, Confer B, Khara HS, Diehl DL. Modified 1 pass, 1 versus 3 actuation wet suction technique for endoscopic ultrasound guided liver biopsy (EUS-LB): a randomized prospective trial. GIE. 2018;87(6):AB457-AB458.

  23. Nieto J, Khaleel H, Challita Y, et al. EUS-guided fine-needle core liver biopsy sampling using a novel 19-gauge needle with modified 1-pass, 1 actuation wet suction technique. Gastrointest Endosc. 2017;85:AB494–5.

    Article  Google Scholar 

  24. Baunsgaard P, Sanchez GC, Lundborg CJ. The variation of pathological changes in the liver evaluated by double biopsies. Acta Pathol Microbiol Scand Sect A Pathol. 2009;87A(1–6):51–7. https://doi.org/10.1111/j.1699-0463.1979.tb00023.x.

    Article  Google Scholar 

  25. Abdi W, Millan JC, Mezey E. Sampling variability on percutaneous liver biopsy. Arch Intern Med. 1979;139:667–9. https://doi.org/10.1001/archinte.1979.03630430043014.

    Article  CAS  PubMed  Google Scholar 

  26. Maharaj B, Leary WP, Naran AD, Maharaj RJ, Cooppan RM, Pirie D, et al. Sampling variability and its influence on the diagnostic yield of percutaneous needle biopsy of the liver. Lancet. 1986;327:523–5. https://doi.org/10.1016/S0140-6736(86)90883-4.

    Article  Google Scholar 

  27. Diehl DL. Endoscopic ultrasound-guided liver biopsy. In: Adler DG, editor. Interventional Endoscopic Ultrasound. New York, NY USA, Springer; 2019. https://doi.org/10.1007/978-3-319-97376-0.

    Chapter  Google Scholar 

  28. • Huang JY, Samarasena JB, Tsujino T, et al. EUS-guided portal pressure gradient measurement with a simple novel device: a human pilot study. Gastrointest Endosc. 2017;85(5):996–1001. https://doi.org/10.1016/j.gie.2016.09.026 EUS-guided portal pressure gradient measurement is likely to be adopted after more clinical data is accumulated.

    Article  PubMed  Google Scholar 

  29. Huang JY, Samarasena JB, Tsujino T, Chang KJ. EUS-guided portal pressure gradient measurement with a novel 25-gauge needle device versus standard transjugular approach: a comparison animal study. Gastrointest Endosc. 2016;84(2):358–62. https://doi.org/10.1016/j.gie.2016.02.032.

    Article  PubMed  Google Scholar 

  30. Schulman AR, Ryou M, Aihara H, Abidi W, Chiang A, Jirapinyo P, et al. EUS-guided intrahepatic portosystemic shunt with direct portal pressure measurements: a novel alternative to transjugular intrahepatic portosystemic shunting. Gastrointest Endosc. 2017;85:243–7. https://doi.org/10.1016/j.gie.2016.07.041.

    Article  PubMed  Google Scholar 

  31. Schulman AR, Thompson CC, Ryou M. Endoscopic ultrasound-guided direct portal pressure measurement using a digital pressure wire with real-time remote display: a survival study. J Laparoendosc Adv Surg Tech. 2017;27:1051–4. https://doi.org/10.1089/lap.2017.0032.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Case Western Reserve University—School of Medicine, Cleveland, OH, USA

    Shaffer R. S. Mok

  2. Department of Gastroenterology and Nutrition, Geisinger Medical Center, 100 N. Academy Ave, 21-11, Danville, PA, 17822, USA

    David L. Diehl

Authors
  1. Shaffer R. S. Mok
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David L. Diehl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David L. Diehl.

Ethics declarations

Conflict of Interest

David Diehl reports working as a consultant for Boston Scientific, Medtronic, Olympus America, and Cook Medical. Shaffer Mok reports working as a consultant for Medtronic and grants from Pentax/C2 Therapeutics, outside the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Pancreas and Biliary Tract

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mok, S.R.S., Diehl, D.L. The Role of EUS in Liver Biopsy. Curr Gastroenterol Rep 21, 6 (2019). https://doi.org/10.1007/s11894-019-0675-8

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11894-019-0675-8

Keywords

Search

Navigation