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Gastrointest Endosc. 2019 Aug 19. pii: S0016-5107(19)32140-6. doi: 10.1016/j.gie.2019.08.006. [Epub ahead of print]

EUS-guided core liver biopsy using a 22-gauge fork-tip needle: a prospective blinded trial for histologic and lipidomic evaluation in nonalcoholic fatty liver disease.

Author information

1
Division of Gastroenterology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA.
2
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
3
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
4
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA; Division of Gastroenterology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA. Electronic address: abudayyeh.barham@mayo.edu.

Abstract

BACKGROUND AND AIMS:

Diagnostic tools for non-alcoholic fatty liver disease (NAFLD) detection and prognostication are limited, with histology remaining the criterion standard. We evaluated the feasibility and safety of EUS liver biopsy (EUS-LB) in NAFLD staging.

METHODS:

In a prospective cohort of NAFLD patients with steatohepatitis and early liver fibrosis based on magnetic resonance elastography (MRE), EUS-LB procedures were performed using a 22-gauge fork-tip core biopsy needle. Samples were evaluated by a blinded pathologist. Total aggregate sample length (TASL), number of complete portal triads (CPT), ability to calculate NAFLD Activity Score (NAS), ability to stage liver fibrosis and ability to provide enough core liver tissue for lipidomic analysis were evaluated. Performance of EUS-LB was compared with MRE.

RESULTS:

A total of 41 EUS-LB samples were obtained. The median (IQR) TASL was 2.4 cm (2.00, 2.75). The median number of complete portal tracts (CPT) per TASL was 26 (7, 62). Of the samples, 100% were adequate to call NAS score and a fibrosis stage. All samples provided enough core liver tissue to allow the application of lipidomic testing. A significant positive linear association between EUS-LB detected fibrosis and MRE detected fibrosis was observed (r = 0.469, p < .005). Compared with MRE, EUS-LB established early fibrosis in 13 cases that MRE classified as normal. EUS-LB-related adverse events occurred in 7% and were restricted to postprocedural pain.

CONCLUSIONS:

EUS-LB a viable technique for full NAFLD evaluation and may be superior to MRE in establishing the diagnosis of NASH with early fibrosis.

KEYWORDS:

endoscopic ultrasound; endosonography; lipidomics; nonalcoholic fatty liver disease; obesity; steatohepatitis

PMID:
31437454
DOI:
10.1016/j.gie.2019.08.006

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