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

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.