title: Endoscopic ultrasound-guided liver biopsy: a multicenter experience.
abstract: OBJECTIVE
  Endoscopic ultrasound-guided (EUS) liver biopsy (LB) is proposed as a newer method that offers several advantages over existing techniques for sampling liver tissue. This study evaluated the diagnostic yield of EUS-LB as the primary outcome measure. In addition, the safety of the technique in a large patient cohort was assessed.
  
  
  METHODS
  Patients undergoing EUS for evaluation of elevated liver enzymes or hepatic disease were included in this prospective, non-randomized, multicenter study. EUS-LB was performed with EUS-fine needle aspiration (FNA; 19-gauge needle). Tissue was formalin-fixed and stained with hematoxylin and eosin, and trichrome. Using a microscope micrometer, specimen length was measured and the number of complete portal triads (CPTs) were counted. The main outcome measure was to assess the diagnostic yield of EUS-LB, and to monitor for any procedure-related complications.
  
  
  RESULTS
  Patients (110; median age, 53 years; 62 women) underwent EUS-LB at eight centers. The indication was abnormal liver enzymes in 96 patients. LB specimens sufficient for pathological diagnosis were obtained in 108 of 110 patients (98 %). The overall tissue yield from 110 patients was a median aggregate length of 38 mm (range, 0 - 203), with median of 14 CPTs (range, 0 - 68). There was no statistical difference in the yield between bilobar, left lobe only, or right lobe only biopsies. There was one complication (0.9 %) where self-limited bleeding occurred in a coagulopathic and thrombocytopenic patient. This complication was managed conservatively.
  
  
  CONCLUSIONS
  EUS-guided LB was a safe technique that yields tissue adequate for diagnosis among 98 % of patients evaluated.
authors.affiliation: Geisinger Medical Center, Department of Gastroenterology and Nutrition, Danville, Pennsylvania, United States.
authors.forename: David L
authors.initials: DL
authors.lastname: Diehl
authors.affiliation: Geisinger Medical Center, Department of Gastroenterology and Nutrition, Danville, Pennsylvania, United States.
authors.forename: Amitpal S
authors.initials: AS
authors.lastname: Johal
authors.affiliation: Geisinger Medical Center, Department of Gastroenterology and Nutrition, Danville, Pennsylvania, United States.
authors.forename: Harshit S
authors.initials: HS
authors.lastname: Khara
authors.affiliation: Winthrop University Hospital, Departments of Gastroenterology, Hepatology and Nutrition, Mineola, New York, United States.
authors.forename: Stavros N
authors.initials: SN
authors.lastname: Stavropoulos
authors.affiliation: Indiana University, Department of Gastroenterology and Hepatology, Indianapolis, Indiana, United States.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Haddad
authors.affiliation: University of Alabama at Birmingham, Division of Gastroenterology and Hepatology, Birmingham, Alabama, United States.
authors.forename: Jayapal
authors.initials: J
authors.lastname: Ramesh
authors.affiliation: Florida Hospital, Center for Interventional Endoscopy, Orlando, Florida, United States.
authors.forename: Shyam
authors.initials: S
authors.lastname: Varadarajulu
authors.affiliation: Yale University School of Medicine, Department of Medicine, Section of Digestive Diseases, New Haven, Connecticut, United States.
authors.forename: Harry
authors.initials: H
authors.lastname: Aslanian
authors.affiliation: Dartmouth-Hitchcock Medical Center, Department of Gastroenterology, Lebanon, New Hampshire, United States.
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Gordon
authors.affiliation: Geisinger Medical Center, Department of Gastroenterology and Nutrition, Danville, Pennsylvania, United States.
authors.forename: Frederick K
authors.initials: FK
authors.lastname: Shieh
authors.affiliation: Geisinger Medical Center, Department of Gastroenterology and Nutrition, Danville, Pennsylvania, United States.
authors.forename: Jonh J
authors.initials: JJ
authors.lastname: Pineda-Bonilla
authors.affiliation: Geisinger Medical Center, Department of Gastroenterology and Nutrition, Danville, Pennsylvania, United States.
authors.forename: Theresa
authors.initials: T
authors.lastname: Dunkelberger
authors.affiliation: Indiana University, Department of Pathology and Laboratory Medicine, Indianapolis, Indiana, United States.
authors.forename: Dibson D
authors.initials: DD
authors.lastname: Gondim
authors.affiliation: Geisinger Medical Center, Department of Gastroenterology and Nutrition, Danville, Pennsylvania, United States.
authors.forename: Eric Z
authors.initials: EZ
authors.lastname: Chen