Use of the forward-viewing curvilinear array echoendoscope for combined esophagogastroduodenoscopy and EUS-guided liver biopsy

Dear Editor, Liver biopsy (LB) remains important for diagnostic assessment of liver disease, and the EUS approach to liver biopsy (EUS-LB) has been shown to provide excellent liver core specimens.[1,2] A forward-viewing curvilinear array echoendoscope (FV-CLA) is available and can be used in patients requiring esophagogastroduodenoscopy (EGD) and EUS.[3,4] We evaluated the performance of the FV-CLA instrument in a series of patients requiring both EGD and EUS-LB. The FV-CLA EUS instrument (XGIF-UCT160J-AL5; Olympus, Center Valley, PA) has forward-viewing optics and a 90° curvilinear array sector scanner [Figure 1] with Doppler functionality.Figure 1: Forward-viewing curvilinear array echoendoscope. A, The forward-viewing curvilinear array echoendoscope has a diameter and length similar to those of the linear array echoendoscope. The sector scanning area is 90° rather than 180°. B, Closer view of the EUS transducer (reddish portion) as well as larger channel and forward optics. C, Ninety-degree sector scanning with biopsy needle visible.We reviewed 25 patients undergoing EGD and EUS-LB with the FV-CLA echoendoscope. Liver biopsy was done with wet suction/heparin priming with a 19-gauge biopsy needle (Acquire 19G; Boston Scientific, Marlborough, MA).[5] Unilobar or bilobar EUS-LB was at the discretion of the endosonographer. The left lobe of the liver was imaged through the proximal stomach and the right lobe of the liver with the FV-CLA in the duodenal bulb and then slight counterclockwise torque. EUS examinations were conducted at 7.5 MHz by experienced endosonographers. In all procedures, the FV-CLA was easy to maneuver and provided excellent US images. All procedures were completed successfully with no adverse effects. Because the FV-CLA does not have an elevator, elevation-type movements of the needle were achieved with deflection of the up-down wheel of the scope. The most common reasons for EGD were to evaluate abdominal pain and gastroesophageal reflux evaluation and to rule out esophageal varices. Bilobar LB was performed in 14 patients, left lobe in 10, and right lobe in 1. The most common reasons for LB were abnormal liver function tests, hepatomegaly, and possible cirrhosis on imaging. In all cases, adequate LB cores were obtained for a pathologic diagnosis with median length of the longest piece 12.2 mm (range, 5.3–22.6 mm) for the left lobe and 13.4 mm (range, 5.8–28.0 mm) for the right lobe. When a patient who requires an LB also has an indication for EGD, EUS-guided liver biopsy is the most cost-effective and efficient approach. The FV-CLA echoendoscope enables full endoscopic examination of the upper digestive tract with excellent liver imaging and needle biopsy in patients who require both an EGD and LB. Both procedures can be performed with thee FV-CLA echoendoscope in an expeditious manner, without the need for a second endoscope. Although the scanning sector of the FV-CLA echoendoscope is smaller (90° rather than 180°), liver visualization of both lobes is excellent, and biopsy of both hepatic lobes is straightforward. Presentation at a meeting Research abstract was presented as poster at the American College of Gastroenterology Annual Scientific Meeting 2022 in Charlotte, NC, on October 24, 2022. Sources of Funding None.