Skip to main content
SpringerLink
Log in

Endoscopic Ultrasound-Guided Liver Biopsy

  • Chapter
  • First Online:
Interventional Endoscopic Ultrasound

Abstract

Endoscopic-guided liver biopsy (EUS-LB) is a more recent approach to doing parenchymal liver biopsy, complementing the current methods of percutaneous or transjugular biopsy. Studies have shown that tissue yields are comparable between the methods. For patients who require an endoscopy or an EUS in addition to a liver biopsy, EUS-LB allows combining both procedures at the same time, which is more convenient for patients and can lower health care costs. This chapter will review the technique of EUS-LB, with specific attention paid to needle selection and preparation, endosonographic identification of targets, post-procedure recovery, possible adverse events, as well as tissue handling after liver biopsy. A section is included regarding considerations that the pathologist should keep in mind. Future directions for clinical applications and research are also discussed.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 99.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD, American Association for the Study of Liver Diseases. Liver biopsy. Hepatology. 2009;49(3):1017–44.

    Article  Google Scholar 

  2. Caldwell S. Liver biopsy: the reports of its demise are greatly exaggerated. Clin Transl Gastroenterol. 2016;7:e171.

    Article  Google Scholar 

  3. Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med. 2001;344(7):495–500.

    Article  CAS  Google Scholar 

  4. Lebrec D, Goldfarb G, Degott C, Rueff B, Benhamou JP. Transvenous liver biopsy: an experience based on 1000 hepatic tissue samplings with this procedure. Gastroenterology. 1982;83(2):338–40.

    CAS  PubMed  Google Scholar 

  5. Bull HJ, Gilmore IT, Bradley RD, Marigold JH, Thompson RP. Experience with transjugular liver biopsy. Gut. 1983;24(11):1057–60.

    Article  CAS  Google Scholar 

  6. 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.

    Article  Google Scholar 

  7. Ring EJ, Lake JR, Roberts JP, Gordon RL, LaBerge JM, Read AE, et al. Using transjugular intrahepatic portosystemic shunts to control variceal bleeding before liver transplantation. Ann Intern Med. 1992;116:304–9.

    Article  CAS  Google Scholar 

  8. tenBerge J, Hoffman BJ, Hawes RH, Van Enckevort C, Giovannini M, Erickson RA, et al. EUS-guided fine needle aspiration of the liver: indications, yield, and safety based on an international survey of 167 cases. Gastrointest Endosc. 2002;55(7):859–62.

    Article  Google Scholar 

  9. DeWitt J, LeBlanc J, McHenry L, Ciaccia D, Imperiale T, Chappo J, et al. Endoscopic ultrasound-guided fine needle aspiration cytology of solid liver lesions: a large single-center experience. Am J Gastroenterol. 2003;98(9):1976–81.

    PubMed  Google Scholar 

  10. Mathew A. EUS-guided routine liver biopsy in selected patients. Am J Gastroenterol. 2007;102(10):2354–5.

    Article  Google Scholar 

  11. 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.

    Article  Google Scholar 

  12. Dewitt J, McGreevy K, Cummings O, Sherman S, Leblanc JK, McHenry L, et al. Initial experience with EUS-guided Tru-cut biopsy of benign liver disease. Gastrointest Endosc. 2009;69(3):535–42.

    Article  Google Scholar 

  13. Acosta R, Twadell W, Darwin P. Adequacy of EUS guided true cut liver biopsy. Gastrointest Endosc. 2009;69(5):AB331.

    Article  Google Scholar 

  14. Stavropoulos SN, Im GY, Jlayer Z, Harris MD, Pitea TC, Turi GK, 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.

    Article  Google Scholar 

  15. Diehl DL, Johal AS, Khara HS, Stavropoulos SN, Al-Haddad M, Ramesh J, et al. Endoscopic ultrasound-guided liver biopsy: a multicenter experience. Endosc Int Open. 2015;3(3):E210–5.

    Article  Google Scholar 

  16. Pineda JJ, Diehl DL, Miao CL, Johal AS, Khara HS, Bhanushali A, 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.

    Article  Google Scholar 

  17. Stine JG, Liss G, Lewis JH. The safety of same-day endoscopy and percutaneous liver biopsy. Dig Dis Sci. 2011;56(4):1201–6.

    Article  Google Scholar 

  18. Johal AS, Khara HS, Maksimak MG, Diehl DL. Endoscopic ultrasound-guided liver biopsy in pediatric patients. Endosc Ultrasound. 2014;3(3):191–4.

    Article  Google Scholar 

  19. Bhatia V, Hijioka S, Hara K, Mizuno N, Imaoka H, Yamao K. Endoscopic ultrasound description of liver segmentation and anatomy. Dig Endosc. 2014;26(3):482–90.

    Article  Google Scholar 

  20. Larson SP, Bowers SP, Palekar NA, et al. Histopathologic variability between the right and left lobes of the liver in morbidly obese patients undergoing Roux-en-Y bypass. Clin Gastroenterol Hepatol. 2007;5(11):1329–32.

    Article  Google Scholar 

  21. Sey MS, 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.

    Article  Google Scholar 

  22. 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.

    Article  Google Scholar 

  23. Shah ND, Sasatomi E, Baron TH. Endoscopic ultrasound-guided parenchymal liver biopsy: single center experience of a new dedicated core needle. Clin Gastroenterol Hepatol. 2017;15(5):784–6.

    Article  Google Scholar 

  24. Ching-Campanioni R, Diehl DL, Confer B, et al. ClinicalTrials.gov Identifier: NCT03408171.

    Google Scholar 

  25. Mok SR, Diehl DL, Johal AS, Khara HS, Diehl M, Mudireddy PR, Confer B, Chen ZE. 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.

    Article  Google Scholar 

  26. Katanuma A, Itoi T, Baron TH, Yasuda I, Kin T, Yane K, et al. Bench-top testing of suction forces generated through endoscopic ultrasound-guided aspiration needles. J Hepatobiliary Pancreat Sci. 2015;22(5):379–85.

    Article  Google Scholar 

  27. Berzosa M, Villa N, Bartel M, Wallace M, Tau J, Trang T, et al. Mo1420 pilot study comparing hybrid vs. wet vs. dry suction techniques for EUS-FNA of solid lesions. Gastrointest Endosc. 2014;79((5):AB430.

    Article  Google Scholar 

  28. 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.

    Article  Google Scholar 

  29. Diehl DL, Mok SR, Johal AJ, et al. Heparin priming of EUS-FNA needles does not adversely affect tissue cytology or immunohistochemical staining. Endosc Int Open. 2018;6:E356.

    Article  Google Scholar 

  30. Nieto J, Khaleel H, Challita Y, Jimenez M, Baron TH, Walters L, et al. EUS-guided fine-needle core liver biopsy sampling using a novel 19-gauge needle with modified one pass, one actuation wet suction technique. Gastrointest Endosc. 2017;67(2):469–75.

    Article  Google Scholar 

  31. Crawford AR, Lin XZ, Crawford JM. The normal adult human liver biopsy: a quantitative reference standard. Hepatology. 1998;28(2):323–31.

    Article  CAS  Google Scholar 

  32. Rocken C, Meier H, Klauck S, Wolff S, Malfertheiner P, Roessner A. Large-needle biopsy versus thin-needle biopsy in diagnostic pathology of liver diseases. Liver. 2001;21(6):391–7.

    Article  CAS  Google Scholar 

  33. Colloredo G, Guido M, Sonzogni A, Leandro G. Impact of liver biopsy size on histological evaluation of chronic viral hepatitis: the smaller the sample, the milder the disease. J Hepatol. 2003;39(2):239–44.

    Article  Google Scholar 

  34. Riaz Z, Wright M. Advances in clinical hepatology and what the hepatologist expects from a liver biopsy result. Diagn Histopathol. 2014;20(3):95–101.

    Article  Google Scholar 

  35. Nakanishi Y, Mneimneh WS, Sey M, Al-Haddad M, DeWitt JM, Saxena R. One hundred thirteen consecutive transgastric liver biopsies for hepatic parenchymal diseases: a single-institution study. Am J Surg Pathol. 2015;39(7):968–76.

    Article  Google Scholar 

  36. Eisenberg E, Konopniki M, Veitsman E, Kramskay R, Gaitini D, Baruch Y. Prevalence and characteristics of pain induced by percutaneous liver biopsy. Anesth Analg. 2003;96(5):1392–6.

    Article  CAS  Google Scholar 

  37. Akhtar M, Ahmad M, Rehman A. Frequency of pain associated with ultrasound guided percutaneous liver biopsy. J Postgrad Med Inst. 2012;26(4):24.

    Google Scholar 

  38. Firpi RJ, Soldevila-Pico C, Abdelmalek MF, Morelli G, Judah J, Nelson DR. Short recovery time after percutaneous liver biopsy: should we change our current practices? Clin Gastroenterol Hepatol. 2005;3(9):926–9.

    Article  Google Scholar 

  39. Shah N, Huseini MS, Chen ZM, Persing K, Zeiber H, Diehl DL, Johal AS, Khara HS. Effective resource utilization with an early discharge protocol for EUS-guided liver biopsy. Am J Gastroenterol. 2015;110:S978–80.

    Article  Google Scholar 

  40. Perrault J, McGill DB, Ott BJ, Taylor WF. Liver biopsy: complications in 1000 inpatients and outpatients. Gastroenterology. 1978;74(1):103–6.

    CAS  PubMed  Google Scholar 

  41. Piccinino F, Sagnelli E, Pasquale G, Giusti G. Complications following percutaneous liver biopsy. A multicentre retrospective study on 68,276 biopsies. J Hepatol. 1986;2(2):165–73.

    Article  CAS  Google Scholar 

  42. McGill DB, Rakela J, Zinsmeister AR, Ott BJ. A 21-year experience with major hemorrhage after percutaneous liver biopsy. Gastroenterology. 1990;99(5):1396–400.

    Article  CAS  Google Scholar 

  43. Janes CH, Lindor KD. Outcome of patients hospitalized for complications after outpatient liver biopsy. Ann Intern Med. 1993;118(2):96–8.

    Article  CAS  Google Scholar 

  44. Huang JF, Hsieh MY, Dai CY, Hou NJ, Lee LP, Lin ZY, et al. The incidence and risks of liver biopsy in non-cirrhotic patients: an evaluation of 3806 biopsies. Gut. 2007;56(5):736–7.

    Article  Google Scholar 

  45. Myers RP, Fong A, Shaheen AA. Utilization rates, complications and costs of percutaneous liver biopsy: a population-based study including 4275 biopsies. Liver Int. 2008;28(5):705–12.

    Article  Google Scholar 

  46. Huang JY, Samarasena JB, Tsujino T, Lee J, Hu KQ, McLaren CE, et al. EUS-guided portal pressure gradient measurement with a simple novel device: a human pilot study. Gastrointest Endosc. 2017;85(5):996–1001.

    Article  Google Scholar 

  47. 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.

    Article  Google Scholar 

  48. Schulman AR, Thompson CC, Ryou M. EUS-guided portal pressure measurement using a digital pressure wire with real-time remote display: a novel, minimally invasive technique for direct measurement in an animal model. Gastrointest Endosc. 2016;83(4):817–20.

    Article  Google Scholar 

  49. Schulman AR, Ryou M, Aihara H, Abidi W, Chiang A, Jirapinyo P, Sakr A, Ajeje E, Ryan MB, Thompson CC. EUS-guided intrahepatic portosystemic shunt with direct portal pressure measurements: a novel alternative to transjugular intrahepatic portosystemic shunting. Gastrointest Endosc. 2017;85(1):243–7.

    Article  Google Scholar 

  50. Rowe IA, Parker R. Liver biopsy for the selection of patients with nonalcoholic steatohepatitis for clinical trials. Gastroenterology. 2015;148:262.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Geisinger Commonwealth School of Medicine, Scranton, PA, USA

    David L. Diehl

  2. Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, PA, USA

    David L. Diehl

Authors
  1. David L. Diehl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David L. Diehl .

Editor information

Editors and Affiliations

  1. Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT, USA

    Douglas G. Adler, MD, FACG, AGAF, FASGE

Electronic Supplementary Material

Technique of EUS-guided liver biopsy (MP4 379190 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Diehl, D.L. (2019). Endoscopic Ultrasound-Guided Liver Biopsy. In: Adler, MD, FACG, AGAF, FASGE, D. (eds) Interventional Endoscopic Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-319-97376-0_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-97376-0_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-97375-3

  • Online ISBN: 978-3-319-97376-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation