Endoscopic ultrasonography - emerging applications in hepatology

Table 1 Data from the main studies of endoscopic ultrasonography-guided liver biopsy

Ref.	Study design	Needle	Passes	Specimen length (median)	Complete portal tracts (median)	Histological diagnosis
DeWitt et al[8]	Prospective unicentre study n = 21	Quick-Core1	1-4	9 mm	2	71%
Diehl et al[11]	Prospective multicentre study n = 110	19G (FNA) Expect1	1-2	38 mm	14	98%
Stavropoulos et al[10]	Prospective unicentre study n = 22	19G (FNA) Echotip2	1-3	36.9 mm	9	91%
Sey et al[9]	Prospective unicentre study n = 75	Quick-Core1	1-7	9 mm	2	73%
		ProCore 19G1	1-3	20 mm	5	97%

¹Cook^® Medical;

²Boston Scientific. FNA: Fine needle aspiration.

Table 2 Reported diagnostic yields of endoscopic ultrasonography of focal liver lesions

Ref./study design	Study population	Patient number/EUS-FNA	EUS diagnostic yield	EUS-FNA diagnostic yield
Awad et al[13] Prospective unicenter study	Suspected HCC or metastatic liver carcinoma	14/9	EUS identified all hepatic lesions (n = 14) previously reported by CT 4 new/additional lesions identified by EUS	All FNA passes yielded adequate specimens (malignant: n = 8; benign: n = 1)
Singh et al[14] Prospective unicenter study	High risk for HCC	17/16	The diagnostic accuracy of US, CT, MRI, and EUS/EUS-FNA were 38%, 69%, 92%, and 94%	Cytologic diagnosis of primary liver tumor was established in 8 cases (HCC = 7; cholangiocarcinoma = 1)
DeWitt et al[15] Retrospective unicenter study	Staging EUS examinations for known or suspected malignancy	77/77	EUS features predictive of malignant hepatic lesions were the presence of regular outer margins and the detection of two or more lesions	45 aspirates were diagnostic for malignancy (metastasis: n = 44; HCC = 1)

HCC: Hepatocellular carcinoma; EUS: Endoscopic ultrasonography; FNA; Fine needle aspiration; US: Ultrasonography; CT: Computed tomography; MRI: Magnetic resonance imaging.

Table 3 Role of endoscopic ultrasonography in the evaluation of the outcome of endoscopic therapeutics for esophageal varices

Ref.	Study design	Endoscopic findings	EUS findings
Masalaite et al[35]	Prospective The role of EUS in predicting the recurrence/rebleeding of esophageal varices: EBL (n = 40)	Recurrence of esophageal varices: 19 (47.5%) within 12 mo of EBL	EUS independent prognostic factors for variceal recurrence: Severe esophageal collaterals (OR= 24.39) multiple esophageal collaterals (OR = 24.39)
Lo et al[39]	Prospective The role of EUS in predicting the recurrence of esophageal varices: ES (n = 35) vs EBL (n = 44)	Recurrence of esophageal varices: 43% ES vs 70% EBL	Paraesophageal varices: 51% ES vs 86% EBL
de Paulo et al[40]	Prospective The role of EUS-guided ES: ES (n = 25) vs EUS-guided ES (n = 25) of esophageal collateral vessels	Mean number of sessions until eradication: 4.3 ES group vs 4.1 for the EUS-ES Recurrence of esophageal varices: 16.7% ES vs 8.3% EUS-ES	Esophageal collaterals at the end of the sclerotherapy program: 8 patients in ES vs 0 patients in EUS-ES

EUS: Endoscopic ultrasonography; EBL: Endoscopic band ligation; ES: Endoscopic sclerotherapy.