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EUS imaging for the diagnosis of nonalcoholic fatty liver disease

Published:December 12, 2021DOI:https://doi.org/10.1016/j.gie.2021.11.048

      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)
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      Linked Article

      • EUS for prediction of hepatic steatosis requires further substantiation
        Gastrointestinal EndoscopyVol. 95Issue 5
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          We 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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