title: High yield of same-session EUS-guided liver biopsy by 19-gauge FNA needle in patients undergoing EUS to exclude biliary obstruction.
abstract: BACKGROUND
  EUS-guided liver biopsy by Trucut yields variable specimen adequacy at high cost, limiting its utility. A modified EUS-guided technique with reliable adequacy could be a viable alternative to standard techniques in cost-effective clinical settings.
  
  
  OBJECTIVE
  To describe our experience with EUS-guided liver biopsy by 19-gauge FNA, non-Trucut, needle in a cost-effective setting: patients with abnormal liver test results of unclear etiology referred for EUS to exclude biliary obstruction in whom an unrevealing EUS would have prompted a next-step liver biopsy by the referring physician.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  Tertiary-care teaching hospital.
  
  
  METHODS
  Consecutive patients with abnormal liver tests referred for EUS.
  
  
  METHODS
  EUS-guided liver biopsy by 19-gauge FNA needle (non-Trucut).
  
  
  METHODS
  Diagnostic yield, specimen adequacy, and complications. An adequate specimen was defined as a length of 15 mm or longer and 6 or more complete portal tracts (CPTs).
  
  
  RESULTS
  Between July 2008 and July 2011, 22 of 31 consecutive patients meeting inclusion criteria underwent unrevealing EUS with same-session EUS-guided liver biopsy by 19-gauge FNA needle. A median of 2 FNA passes (range 1-3) yielded a median specimen length of 36.9 mm (range 2-184.6 mm) with a median of 9 CPTs (range 1-73 CPTs). EUS-guided liver biopsies yielded a histologic diagnosis and adequate specimens in 20 of 22 patients (91%). Expanded experience led to improved specimen adequacy. There were no complications.
  
  
  CONCLUSIONS
  Small study size.
  
  
  CONCLUSIONS
  EUS-guided liver biopsy by using a 19-gauge FNA needle appears to be feasible and safe and provides excellent diagnostic yield and specimen adequacy.
authors.affiliation: Department of Gastroenterology, Hepatology and Nutrition, Winthrop-University Hospital, Mineola, New York, USA.
authors.forename: Stavros N
authors.initials: SN
authors.lastname: Stavropoulos
authors.forename: Gene Y
authors.initials: GY
authors.lastname: Im
authors.forename: Zahra
authors.initials: Z
authors.lastname: Jlayer
authors.forename: Michael D
authors.initials: MD
authors.lastname: Harris
authors.forename: Teodor C
authors.initials: TC
authors.lastname: Pitea
authors.forename: George K
authors.initials: GK
authors.lastname: Turi
authors.forename: Peter F
authors.initials: PF
authors.lastname: Malet
authors.forename: David M
authors.initials: DM
authors.lastname: Friedel
authors.forename: James H
authors.initials: JH
authors.lastname: Grendell
mesh_terms: D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002779:Cholestasis / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D019160:Endosonography; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018084:Ultrasonography, Interventional / Q000009:adverse effects