EUS-guided Liver Biopsy and Portosystemic Pressure Gradient Assessment (Using Modified Non-proprietary Setup) in...

Endoscopic ultrasound (EUS)-liver biopsy (EUS-LB) may be ideally suited in patients with suspected compensated advanced chronic liver disease (cACLD) or cirrhosis as many require endoscopy for variceal screening. However, data in this population are scant. Simultaneous portosystemic pressure gradient (PPG) assessment makes EUS an alternative to transjugular liver biopsy and hepatic venous pressure gradient. Most studies have measured EUS-PPG using a proprietary manometer (unavailable in India). We describe the technical feasibility, efficacy, and safety of EUS-LB and EUS-PPG (using a modified non-proprietary setup) in suspected cACLD and cirrhosis. We also describe a method for ex vivo validation of our PPG setup.

Data of patients with suspected cACLD (liver stiffness measurement>10 kPa) or cirrhosis who underwent the assessment over 3-years were reviewed. The primary outcome was pathologists' assessment of sample adequacy for giving a professional opinion regarding diagnosis. Secondary outcomes included aggregate core length, longest core length, number of complete portal tracts (CPTs), fibrosis stage, etiology, adverse events and for EUS-PPG technical feasibility, correlation with fibrosis, and safety.

Of 155 EUS-LBs, 153 (98.7%) were deemed adequate by a histopathologist for giving a professional opinion. ACL and LCL were 30.3 ± 13.3 mm and 10.8 ± 3.1 mm. ACL ≥20 mm and ≥10 mm were noted in 121 (78.1%) and 150 (96.8%) samples, respectively. Complete portal tracts (CPTs)≥11 and ≥ 6 were observed in 33 (21.3%) and 95 (61.3%) samples. Overall, 84.8% patients had F3/F4 fibrosis. Etiologic diagnosis was possible in 99.3%. Adverse events were infrequent (4.6%). EUS-PPG was performed in 34 patients with 100% technical success and no adverse events. Portal hypertension and clinically significant portal hypertension were detected in 9 (26.5%) and 6 (17.6%) patients, respectively. PPG correlated strongly with histologic fibrosis (rho = 0.83, P < 0.001).

EUS-LB and EUS-PPG is feasible and safe in cACLD and cirrhosis.

Not applicable.