Center for Interventional Endoscopy, AdventHealth Orlando, Florida, USA.
Department of Internal Medicine, AdventHealth Orlando, Florida, USA.
Endoscopy. 2019 Sep;51(9):818-824. doi: 10.1055/a-0967-3640. Epub 2019 Jul 31.
Endoscopic ultrasound-guided liver biopsy (EUS-LB) using a 19-gauge (19-G) EUS needle is becoming increasingly popular. We evaluated the efficacy and safety of a 22-G EUS fine needle biopsy (FNB) needle for performing EUS-LB.
Patients referred for evaluation of elevated liver enzymes and without obstructive disease requiring endoscopic retrograde cholangiopancreatography (ERCP) were included. Using a 22-G FNB needle, two passes were made from the left lobe and one from the right. The main outcome measure was adequacy of the specimen for histology interpretation, and the secondary outcome was the safety of EUS-guided liver biopsy with a 22-G FNB needle. Patients were followed for post-procedure complications for 30 days.
40 patients (median age 61 years; 26 women) underwent EUS-LB. Analyzing by needle passes, the median longest core fragment was 12 mm (1st quartile - 3rd quartile 10 mm - 16.25 mm, interquartile range [IQR] 6.25 mm) from the left lobe and 11 mm (10 mm - 15.75 mm, IQR 5.75 mm) from the right lobe. The median cumulative core length per patient was 55 mm (44.5 mm - 68 mm, IQR 23.5 mm). The median cumulative number of complete portal triads (CPTs) per patient was 42 (28.5 - 53, IQR 24.5). The specimen was considered adequate in all 40 patients (100 %). Self-limiting abdominal pain was reported in 6 patients (15 %).
EUS-LB using a 22-G FNB needle is a safe and viable alternative to the use of larger gauge needles, yielding adequate tissue for evaluation of parenchymal disease in 100 % of the patients.
使用 19 号（19-G）内镜超声引导针（EUS）进行肝活检（EUS-LB）越来越受欢迎。我们评估了 22-G 超声细针活检（FNB）针用于 EUS-LB 的疗效和安全性。
纳入因肝酶升高而就诊且无需要内镜逆行胰胆管造影（ERCP）治疗的阻塞性疾病的患者。使用 22-G FNB 针，从左叶进行两次穿刺，从右叶进行一次穿刺。主要观察指标为组织学解释标本的充分性，次要观察指标为 22-G FNB 针 EUS 引导下肝活检的安全性。对患者进行 30 天的术后并发症随访。
40 例患者（中位年龄 61 岁；26 例女性）接受了 EUS-LB。按针道分析，左叶最长核心片段的中位数为 12mm（1 四分位数-3 四分位数 10mm-16.25mm，四分位距[IQR]6.25mm），右叶为 11mm（10mm-15.75mm，IQR 5.75mm）。每位患者的中位累计核心长度为 55mm（44.5mm-68mm，IQR 23.5mm）。每位患者的中位累计完整门脉三联体（CPT）数量为 42（28.5-53，IQR 24.5）。40 例患者的标本均被认为充分（100%）。6 例（15%）患者报告出现自限性腹痛。
使用 22-G FNB 针进行 EUS-LB 是一种安全可行的替代方法，与使用更大口径的针相比，可使 100%的患者获得足够的组织进行实质疾病的评估。
