Background and Aims
Diagnostic tools for nonalcoholic fatty liver disease (NAFLD) detection and prognostication
are limited, with histology remaining the criterion standard. We evaluated the feasibility
and safety of EUS-guided liver biopsy (EUS-LB) sampling 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 sampling 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,
ability to calculate NAFLD activity score, ability to stage liver fibrosis, and ability
to provide enough core liver tissue for lipidomics analysis were evaluated. Performance
of EUS-LB sampling was compared with MRE.
Results
Forty-one EUS-LB samples were obtained. The median TASL was 2.4 cm (interquartile
range, 2.00-2.75). The median number of complete portal triads per TASL was 26 (interquartile
range, 7-62). Of the samples, 100% were adequate to convey NAFLD activity score and
fibrosis stage. All samples provided enough core liver tissue to allow the application
of lipidomics testing. A significant positive linear association between EUS-LB sampling–detected
fibrosis and MRE-detected fibrosis was observed (r = .469, P < .005). Compared with MRE, EUS-LB sampling established early fibrosis in 13 cases
that MRE classified as normal. EUS-LB sampling–related adverse events occurred in
7% and were restricted to postprocedural pain.
Conclusions
EUS-LB sampling is a viable technique for full NAFLD evaluation and may be superior
to MRE in establishing the diagnosis of nonalcoholic steatohepatitis with early fibrosis.
(Clinical trial registration number: NCT02880189.)
Abbreviations:
CPT (complete portal triad), EUS-LB (EUS-guided liver biopsy), FNB (fine-needle biopsy), MRE (magnetic resonance elastography), NAFLD (nonalcoholic fatty liver disease), NASH (nonalcoholic steatohepatitis), TASL (total aggregate sample length)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 19, 2019
Accepted:
August 4,
2019
Received:
May 15,
2019
Footnotes
DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: B. K. Abu Dayyeh: Research support from Medtronic; A. C. Storm: Consultant for GI Dynamics, Enod-TAGSS, research support from Boston Scientific, Apollo Endosurgery. All other authors disclosed no financial relationships relevant to this publication. Research support for this study was provided by Medtronic (provided needles) and John Derry Endowment.
See CME section; p. 971.
If you would like to chat with an author of this article, you may contact Dr Abu Dayyeh at [email protected]
Identification
Copyright
© 2019 by the American Society for Gastrointestinal Endoscopy
