Background and Aims
EUS is increasingly used to evaluate patients with liver disease, but its role in
assessing hepatic steatosis has not been reported. The goal of our study was to assess
the accuracy of EUS for diagnosing hepatic steatosis.
Methods
We identified all patients who underwent EUS-guided liver biopsy sampling at our institution.
All digitally stored EUS liver images were reviewed by a single radiologist, who rated
the severity of liver echogenicity using a 4-point US scale. Liver biopsy specimens
for all study patients were reviewed by a single liver pathologist, who rated them
for steatosis and fibrosis using Nonalcoholic Steatohepatitis Clinical Research Network
criteria. Receiver operator characteristic curves were used to assess the diagnostic
accuracy of EUS for hepatic steatosis for all patients and in a subgroup analysis
for obese and nonobese patients.
Results
During the study period, 76 patients underwent EUS-guided liver biopsy sampling. The
average age of study patients was 56.5 years, 50% were women, and 43.2% were obese.
The accuracy for EUS for the diagnosis of hepatic steatosis was .8 (95% confidence
interval [CI], .7-.89). The accuracy of EUS for the diagnosis of hepatic steatosis
in obese patients was .93 (95% CI, .8-.99) and in nonobese patients was .69 (95% CI,
.54-.83). For obese patients, EUS had a positive predictive value of 89.7% and a negative
predictive value of 75%. The finding of course echotexture on EUS had an accuracy
of 79% for the diagnosis of grade 3 fibrosis or cirrhosis.
Conclusions
EUS is a useful tool for the diagnosis of hepatic steatosis, particularly in obese
patients in whom abdominal US has modest accuracy.
Abbreviations:
CI (confidence interval), NAFLD (nonalcoholic fatty liver disease), NPV (negative predictive value), PPV (positive predictive value)To read this article in full you will need to make a payment
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References
- Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008.Clin Gastroenterol Hepatol. 2011; 9 (quiz e60): 524-530
- The economic and clinical burden of nonalcoholic fatty liver disease in the United States and Europe.Hepatology. 2016; 64: 1577-1586
- Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity.Hepatology. 2004; 40: 1387-1395
- Independent association between nonalcoholic fatty liver disease and cardiovascular disease in the US population.Clin Gastroenterol Hepatol. 2012; 10: 646-650
- The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases.Hepatology. 2018; 67: 328-357
- Polycystic ovary syndrome, androgen excess, and the risk of nonalcoholic fatty liver disease in women: a longitudinal study based on a United Kingdom primary care database.PLoS Med. 2018; 15e1002542
- Reversal of nonalcoholic hepatic steatosis, hepatic insulin resistance, and hyperglycemia by moderate weight reduction in patients with type 2 diabetes.Diabetes. 2005; 54: 603-608
- Prevalence of non-alcoholic fatty liver disease: population based study.Ann Hepatol. 2007; 6: 161-163
- Endoscopic ultrasound-guided parenchymal liver biopsy: a systematic review and meta-analysis.Surg Endosc. 2021; 35: 5546-5557
- EUS-guided portal pressure gradient measurement with a simple novel device: a human pilot study.Gastrointest Endosc. 2017; 85: 996-1001
- EUS-guided portal pressure gradient measurement with a simple novel device: a human pilot study.VideoGIE. 2018; 3: 361-363
- The utility of radiological imaging in nonalcoholic fatty liver disease.Gastroenterology. 2002; 123: 745-750
- Pathogenesis and prevention of hepatic steatosis.Gastroenterol Hepatol. 2015; 11: 167-175
- Design and validation of a histological scoring system for nonalcoholic fatty liver disease.Hepatology. 2005; 41: 1313-1321
- Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis.Hepatology. 2011; 54: 1082-1090
- Bi-lobar liver biopsy via EUS enhances the assessment of disease severity in patients with non-alcoholic steatohepatitis.Hepatol Int. 2019; 13: 323-329
- Fatty liver disease in severe obese patients: diagnostic value of abdominal ultrasound.World J Gastroenterol. 2008; 14: 1415-1418
- The role of ultrasound in the diagnosis of hepatic steatosis in morbidly obese patients.Obes Surg. 2004; 14: 635-637
- Prevalence of liver steatosis and fibrosis and the diagnostic accuracy of ultrasound in bariatric surgery patients.Obes Surg. 2012; 22: 240-247
- Endoscopic ultrasound-guided parenchymal liver biopsy: a systematic review and meta-analysis.Surg Endosc. 2021; 35: 5546-5557
- Endoscopic ultrasound liver biopsies accurately predict the presence of fibrosis in patients with fatty liver.Clin Gastroenterol Hepatol. 2017; 15: 1477-1478
- EUS-guided core liver biopsy sampling using a 22-gauge fork-tip needle: a prospective blinded trial for histologic and lipidomic evaluation in nonalcoholic fatty liver disease.Gastrointest Endosc. 2019; 90: 926-932
- Efficacy and safety of EUS-guided liver biopsy: a systematic review and meta-analysis.Gastrointest Endosc. 2019; 89: 238-246
Article info
Publication history
Published online: December 12, 2021
Accepted:
November 30,
2021
Received:
September 20,
2021
Footnotes
DISCLOSURE: The following authors disclosed financial relationships: D. K. Pleskow: Consultant for Boston Scientific, Olympus, Fujifilm, and Medtronics; stock ownership in Allurion. T. M. Berzin: Consultant for Medtronic and Boston Scientific. All other authors disclosed no financial relationships.
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© 2022 by the American Society for Gastrointestinal Endoscopy
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Access this article on ScienceDirectLinked Article
- EUS for prediction of hepatic steatosis requires further substantiationGastrointestinal EndoscopyVol. 95Issue 5
- PreviewWe read with interest the article by Santisteban et al1 assessing the accuracy of EUS for diagnosing hepatic steatosis. The authors reported the diagnostic accuracy of EUS for hepatic steatosis as 0.8 (95% CI, 0.70-0.89). The diagnostic accuracy was higher for obese patients than for nonobese patients (0.93 vs 0.69). However, we would like to highlight certain points related to this study.
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