EUS guided liver biopsy in patients with suspected cACLD and cirrhosis: a real-life observational study

Background and Aims: Percutaneous liver-biopsy is often technically difficult and relatively contraindicated in patients with compensated advanced chronic liver disease (cACLD) and cirrhosis. EUS-guided liver-biopsy (EUSLB) has emerged as an attractive alternative to percutaneous biopsies. However, data on EUSLB in cACLD and cirrhosis is limited. Hence, we explored the performance of EUSLB in such patients. Methods: Consecutive EUSLB performed in suspected cACLD (LSM>10kPa) or cirrhosis (on imaging) from June-2022 till April-2023 were reviewed. Indications of biopsy included elevated transaminases or etiologic uncertainty where histology was expected to influence management. Biopsy was avoided in those with current ascites, platelet count <50,000/uL or INR >2.5. Primary outcome was the pathologists assessment of sample adequacy for diagnosis. Secondary outcomes included total core length, complete portal tracts (CPT), fibrosis stage and etiology. Results: Sixty biopsies in 58 patients [age: 31 (22-45) years, males: 51.7%] with suspected cACLD or cirrhosis were reviewed. Fifty-eight (96.7%) samples were deemed adequate by the pathologist. Median core length was 26 (16-36) mm. Core length-20 mm was noted in 69% while 96.5% had core length-10mm. The median number of CPT was 6 (3-7). CPT-11 was observed in 17.2% while 55.2% had 6 CPT. Etiological confirmation was possible in all patients, with autoimmune liver disease being the commonest etiology (37.9%), followed by NAFLD/NASH (27.6%). Most of the patients had fibrosis stages F3 (43%) and F4 (38%). Perihepatic bleed was noted in one patient (1.6%) which was controlled with EUS-guided glue injection. Transient needle-track bleed confined to the hepatic parenchyma was seen in 2 patients (3.3%) which settled spontaneously on real time observation with EUS. One patient (1.6%) complained of mild self-limiting pain. Conclusion: EUSLB is safe and has a high diagnostic yield in patients with cACLD and cirrhosis.