Introduction: Liver biopsy (LB) remains an important procedure for diagnosis, despite advancements in non-invasive evaluation. For patients requiring esophagogastroduodenoscopy (EGD) and EUS, a forward-viewing curvilinear array (FV-CLA) echoendoscope may be particularly useful, as this single device combines a gastroscope for video examination along with an echoendoscope. This study evaluated the performance of the FV-CLA echoendoscope to determine whether the theoretical advantages of this hybrid device translate into usability for EGD and EUS-LB procedures.
Methods: EUS evaluations in 25 patients with indications for LB were performed with the FV-CLA. This study was a retrospective review of charts for these patients.
Results: Twenty-five patients (18 female) underwent EUS-LB using the FV-CLA. Mean age of was 51.16 years (median = 52, SD = 13.43). 24 of the patients indicated their race as Caucasian, and 1 Black.
The most common indications for EGD were evaluation of abdominal pain/dyspepsia, GERD, and rule out esophageal varices (Table 1). EGD was unremarkable in 13, inflammation, ulceration, or gastric polyps were found in 10, and 1 with Barrett’s esophagus. Endosonographically, the liver was normal in 9 patients, hyperechoic in 9, and heterogeneous in 7.
Left lobe LB was performed in 10 patients, right lobe LB in 1 patient, and bilobar LB in 14. Reasons for LB were abnormal liver function tests (19 patients), hepatomegaly (4 patients), and possible cirrhosis (2 patients) (see Table 1). Pathological diagnosis was possible in all biopsies. Liver histology showed steatosis in 8 patients, NASH without fibrosis in 7, NASH with fibrosis in 6, cirrhosis in 2, steatosis with fibrosis in 1, and normal histology in 1.
In all cases, there was adequate LB cores for a pathologic diagnosis. Length of longest piece was 13.0 mm (range 5.3 – 22.6) for left lobe and 14.6 mm (5.8 – 28.0) for right. Aggregate specimen length was 49.5 mm (19.0 – 131.9) for biopsies obtained from the left lobe and 39.7 (10.4 – 68.1) from the right.
In all procedures, the FV-CLA was easy to maneuver and provided good images. All procedures were completed successfully with no adverse effects.
Discussion: The FV-CLA echoendoscope allows use of a single scope for EGD and LB. Visualization of both the right hepatic lobe (transduodenal probe location) and left (transgastric probe location) is good, and excellent LB samples can be obtained from both lobes.
