EUS-guided fine-needle liver biopsy in pediatric patients using a modified technique with one-pass, one-actuation wet suction

Background and aims: liver biopsy (LB) can be a valuable tool to determine the etiology of pediatric liver disease. There is limited data on the role of EUS-LB in children. This study evaluated the efficacy and safety of a modified technique -(M)LB-in cases at high risk of bleeding or in obese children. In addition, the tissue yield of EUS-(M)LB and the percutaneous (PC) approach were compared. Methods: a retrospective analysis was performed comparing EUS-(M)LB and PC-LB in children at a tertiary referral center. All consecutive children referred for PC-LB and EUS-LB who had an unexplained liver test abnormality after exclusion of biliary disorders from March 2017 to August 2018 were included. EUS-(M)LB consisted of a one pass wet suction technique using a 19-gauge core needle. A comparison was performed between total specimen length (TSL) and number of complete portal triads (CPTs). Results: the cohort included 28 EUS-(M)LB and 28 PC-LB pediatric cases. Median (IQR) age was 14.5 years (13.4- 16). Median TSL was 8.6 (5.8-9.6) in EUS-(M)LB cases and 7 cm (7-9) in PC-LB cases (p = 0.788). The maximum intact specimen was 2.8 cm (EUS-(M)LB) and 1.6 cm (PC-LB) (p = 0.009). The mean (SD) number of CPTs per sample was 28.2 (7.3) and 11.6 (2.1), respectively (p = 0.001). Adverse events included one case of self-limited abdominal pain in the PC-LB group. Conclusion: EUS-(M)LB has the potential to be a safe and effective alternative diagnostic modality, when compared to PC-LB, to evaluate children with unexplained liver test abnormalities who undergo EUS to evaluate biliary disorders.