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Name of Journal: World Journal of Gastrointestinal EndoscopyManuscript NO: 52111Manuscript?Type: REVIEWEndoscopic ultrasound guided liver biopsy: Recent evidenceJohnson KD et al. EUS liver biopsy Kemmian D Johnson, Passisd Laoveeravat, Eric U Yee, Abhilash Perisetti, Ragesh Babu Thandassery, Benjamin Tharian?Kemmian D Johnson, Department of Internal Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112, United StatesPassisd Laoveeravat, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, United StatesEric U Yee, Department of Pathology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United StatesAbhilash Perisetti, Benjamin Tharian, Department of Internal Medicine, Division of Gastroenterology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United StatesRagesh Babu Thandassery, Department of Internal Medicine, Division of Gastroenterology, Central Arkansas Veterans Health Care System, Little Rock, AR 72205, United StatesAuthor contributions: Johnson KD, Laoveeravat P, Tharian B, Perisetti A, Thandassery RB equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version; Yee EU contributed to this paper with literature review, critical revision and editing, providing pathology expertise and images, and final approval of the manuscript.Corresponding author: Ragesh Babu Thandassery, MD, Assistant Professor, Department of Internal Medicine, Division of Gastroenterology, Central Arkansas Veterans Health Care System, Little Rock, AR 72205, United States. ragesh.thandassery@ Received: October 25, 2019Revised: December 26, 2019Accepted: March 1, 2020Published online: AbstractLiver biopsy (LB) is an essential tool in diagnosing, evaluating and managing various diseases of the liver. As such, histopathological results are critical as they establish or aid in diagnosis, provide information on prognosis, and guide the appropriate selection of medical therapy for patients. Indications for LB include evaluation of persistent elevation of liver chemistries of unclear etiology, diagnosis of chronic liver diseases such as Wilson's disease, autoimmune hepatitis, small duct primary sclerosing cholangitis, work up of fever of unknown origin, amyloidosis and more. Traditionally, methods of acquiring liver tissue have included percutaneous LB (PCLB), transjugular LB (TJLB) or biopsy taken surgically via laparotomy or laparoscopy. However, traditional methods of LB may be inferior to newer methods. Additionally, PCLB and TJLB carry higher risks of adverse events and complications. More recently, endoscopic ultrasound guided LB (EUS-LB) has evolved as an alternative method of tissue sampling that has proven to be safe and effective, with limited adverse events. Compared to PC and TJ routes, EUS-LB may also have a greater diagnostic yield of tissue, be superior for a targeted approach of focal lesions, provide higher quality images and allow for greater patient comfort. These advantages have contributed to the increased use of EUS-LB as a technique for obtaining liver tissue. Herein, we provide a review of the recent evidence of EUS-LB for liver disease.Key words: Liver biopsy; Percutaneous liver biopsy; Transjugular liver biopsy; Endoscopic ultrasound guided liver biopsy; Fine-needle aspiration; Core biopsy; Fine-needle biopsyJohnson KD, Laoveeravat P, Yee EU, Perisetti A, Thandassery RB, Tharian B. Endoscopic ultrasound guided liver biopsy: Recent evidence. World J Gastrointest Endosc 2020; In pressCore tip: Endoscopic ultrasound guided liver biopsy is a safe and effective approach to obtaining liver biopsies that may serve as an alternative to traditional methods. Our goal is to collect and review the most recent data on the advances in endoscopic ultrasound guided liver biopsies, while also weighing the advantages and disadvantages of utilizing conventional methods of liver biopsy (percutaneous liver biopsy, transjugular liver biopsy, surgical liver biopsy). INTRODUCTIONNeedle biopsy of the liver was first performed by Dr. Paul Ehrlich in 1883 ADDIN EN.CITE <EndNote><Cite><Author>Bravo</Author><Year>2001</Year><RecNum>2</RecNum><DisplayText><style face="superscript">[1]</style></DisplayText><record><rec-number>2</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561061577">2</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bravo, A. A.</author><author>Sheth, S. G.</author><author>Chopra, S.</author></authors></contributors><auth-address>Liver Center, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.</auth-address><titles><title>Liver biopsy</title><secondary-title>N Engl J Med</secondary-title></titles><periodical><full-title>N Engl J Med</full-title></periodical><pages>495-500</pages><volume>344</volume><number>7</number><edition>2001/02/15</edition><keywords><keyword>*Biopsy/adverse effects/methods</keyword><keyword>Biopsy, Needle/adverse effects</keyword><keyword>Contraindications</keyword><keyword>Humans</keyword><keyword>Laparoscopy</keyword><keyword>Liver/*pathology</keyword><keyword>Liver Diseases/*pathology</keyword></keywords><dates><year>2001</year><pub-dates><date>Feb 15</date></pub-dates></dates><isbn>0028-4793 (Print)
0028-4793 (Linking)</isbn><accession-num>11172192</accession-num><urls><related-urls><url>;[1]. Since then, the role and technique of tissue sampling has evolved tremendously. Liver biopsy (LB) provides essential clinical information regarding diagnosis, prognosis, evaluation and management of various diseases of the liver ADDIN EN.CITE <EndNote><Cite><Author>Rockey</Author><Year>2009</Year><RecNum>4</RecNum><DisplayText><style face="superscript">[2]</style></DisplayText><record><rec-number>4</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561061673">4</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rockey, D. C.</author><author>Caldwell, S. H.</author><author>Goodman, Z. D.</author><author>Nelson, R. C.</author><author>Smith, A. D.</author><author>American Association for the Study of Liver, Diseases</author></authors></contributors><auth-address>Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX 75390-8887, USA. don.rockey@utsouthwestern.edu</auth-address><titles><title>Liver biopsy</title><secondary-title>Hepatology</secondary-title></titles><periodical><full-title>Hepatology</full-title></periodical><pages>1017-44</pages><volume>49</volume><number>3</number><edition>2009/02/27</edition><keywords><keyword>*Biopsy/adverse effects/methods</keyword><keyword>Contraindications</keyword><keyword>Humans</keyword><keyword>Liver/diagnostic imaging/*pathology</keyword><keyword>Liver Diseases/*diagnosis/pathology/physiopathology</keyword><keyword>Liver Function Tests</keyword><keyword>Radiography</keyword></keywords><dates><year>2009</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1527-3350 (Electronic)
0270-9139 (Linking)</isbn><accession-num>19243014</accession-num><urls><related-urls><url>;[2]. Though patient history, clinical exam, imaging and laboratory tests including serology aid in the initial diagnosis of liver disorders, histological analysis continues to play an essential role in discovering the etiology and magnitude of liver disease, especially when preliminary, less invasive methods of evaluation are inconclusive ADDIN EN.CITE <EndNote><Cite><Author>Larrey</Author><Year>2017</Year><RecNum>5</RecNum><DisplayText><style face="superscript">[3]</style></DisplayText><record><rec-number>5</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561062404">5</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Larrey, D.</author><author>Meunier, L.</author><author>Ursic-Bedoya, J.</author></authors></contributors><auth-address>Liver and Transplantation Unit, Montpellier School of Medicine and IRB-INSERM-1183, Montpellier, France.</auth-address><titles><title>Liver Biopsy in Chronic Liver Diseases: Is There a Favorable Benefit: Risk Balance?</title><secondary-title>Ann Hepatol</secondary-title></titles><periodical><full-title>Ann Hepatol</full-title></periodical><pages>487-489</pages><volume>16</volume><number>4</number><edition>2017/06/15</edition><keywords><keyword>Biopsy</keyword><keyword>Comorbidity</keyword><keyword>Hepatitis, Autoimmune/*diagnosis/epidemiology/pathology</keyword><keyword>Hepatitis, Chronic/*diagnosis/epidemiology/pathology/virology</keyword><keyword>Humans</keyword><keyword>Liver/*pathology/virology</keyword><keyword>Liver Cirrhosis/*diagnosis/epidemiology/pathology/virology</keyword><keyword>Non-alcoholic Fatty Liver Disease/*diagnosis/epidemiology/pathology</keyword><keyword>Predictive Value of Tests</keyword><keyword>Prognosis</keyword><keyword>Risk Factors</keyword><keyword>chronic liver disease</keyword><keyword>cirrhosis</keyword><keyword>co-morbidities</keyword><keyword>fibrosis</keyword><keyword>liver biopsy</keyword></keywords><dates><year>2017</year><pub-dates><date>Jul-Aug</date></pub-dates></dates><isbn>1665-2681 (Print)
1665-2681 (Linking)</isbn><accession-num>28612749</accession-num><urls><related-urls><url>;[3]. Without tissue acquisition, nearly one-third of cases of liver cirrhosis can be overlooked in patients presenting with abnormal liver tests and absent diagnostic serology, though the widespread availability and non-invasive nature of fibro -elastography has helped reduce the need for biopsies ADDIN EN.CITE <EndNote><Cite><Author>Skelly</Author><Year>2001</Year><RecNum>1</RecNum><DisplayText><style face="superscript">[4]</style></DisplayText><record><rec-number>1</rec-number><foreign-keys><key app="EN" db-id="aazz99etopvf9oexpr85aaa62v05p0s22rrs" timestamp="1564886763">1</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Skelly, M. M.</author><author>James, P. D.</author><author>Ryder, S. D.</author></authors></contributors><auth-address>Division of Gastroenterology and Pathology, University Hospital, Queen's Medical Centre, Nottingham, UK.</auth-address><titles><title>Findings on liver biopsy to investigate abnormal liver function tests in the absence of diagnostic serology</title><secondary-title>J Hepatol</secondary-title></titles><pages>195-9</pages><volume>35</volume><number>2</number><edition>2001/10/03</edition><keywords><keyword>Biopsy, Needle</keyword><keyword>Fatty Liver/diagnosis</keyword><keyword>Fatty Liver, Alcoholic/diagnosis</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Liver/*pathology</keyword><keyword>Liver Cirrhosis/diagnosis</keyword><keyword>Liver Diseases/*diagnosis</keyword><keyword>*Liver Function Tests</keyword><keyword>Male</keyword><keyword>Prospective Studies</keyword><keyword>Serologic Tests</keyword></keywords><dates><year>2001</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0168-8278 (Print)
0168-8278 (Linking)</isbn><accession-num>11580141</accession-num><urls><related-urls><url>;[4]. There are several approaches available to acquire a LB. Conventionally, LBs have primarily been performed through the computed tomography (CT) or ultrasound (US) guided percutaneous (PC) route ADDIN EN.CITE <EndNote><Cite><Author>Bravo</Author><Year>2001</Year><RecNum>2</RecNum><DisplayText><style face="superscript">[1]</style></DisplayText><record><rec-number>2</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561061577">2</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bravo, A. A.</author><author>Sheth, S. G.</author><author>Chopra, S.</author></authors></contributors><auth-address>Liver Center, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.</auth-address><titles><title>Liver biopsy</title><secondary-title>N Engl J Med</secondary-title></titles><periodical><full-title>N Engl J Med</full-title></periodical><pages>495-500</pages><volume>344</volume><number>7</number><edition>2001/02/15</edition><keywords><keyword>*Biopsy/adverse effects/methods</keyword><keyword>Biopsy, Needle/adverse effects</keyword><keyword>Contraindications</keyword><keyword>Humans</keyword><keyword>Laparoscopy</keyword><keyword>Liver/*pathology</keyword><keyword>Liver Diseases/*pathology</keyword></keywords><dates><year>2001</year><pub-dates><date>Feb 15</date></pub-dates></dates><isbn>0028-4793 (Print)
0028-4793 (Linking)</isbn><accession-num>11172192</accession-num><urls><related-urls><url>;[1]. In cases in which this approach is contraindicated or unavailable, a fluoroscopy guided transjugular (TJ) approach may be employed, which may be combined with measurement of hemodynamics in the portal systemPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LYWxhbWJva2lzPC9BdXRob3I+PFllYXI+MjAwNzwvWWVh
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ADDIN EN.CITE.DATA [5,6]. Less commonly, a surgeon may perform a LB during laparoscopy/laparotomy ADDIN EN.CITE <EndNote><Cite><Author>Rockey</Author><Year>2009</Year><RecNum>4</RecNum><DisplayText><style face="superscript">[2]</style></DisplayText><record><rec-number>4</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561061673">4</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rockey, D. C.</author><author>Caldwell, S. H.</author><author>Goodman, Z. D.</author><author>Nelson, R. C.</author><author>Smith, A. D.</author><author>American Association for the Study of Liver, Diseases</author></authors></contributors><auth-address>Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX 75390-8887, USA. don.rockey@utsouthwestern.edu</auth-address><titles><title>Liver biopsy</title><secondary-title>Hepatology</secondary-title></titles><periodical><full-title>Hepatology</full-title></periodical><pages>1017-44</pages><volume>49</volume><number>3</number><edition>2009/02/27</edition><keywords><keyword>*Biopsy/adverse effects/methods</keyword><keyword>Contraindications</keyword><keyword>Humans</keyword><keyword>Liver/diagnostic imaging/*pathology</keyword><keyword>Liver Diseases/*diagnosis/pathology/physiopathology</keyword><keyword>Liver Function Tests</keyword><keyword>Radiography</keyword></keywords><dates><year>2009</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1527-3350 (Electronic)
0270-9139 (Linking)</isbn><accession-num>19243014</accession-num><urls><related-urls><url>;[2]. However, there are procedure-related risks including mortality related to traditional methods of acquiring liver tissue. Major complications following LB are rare, occurring at a rate of approximately 1%, while mortality rates occur at 0.2% ADDIN EN.CITE <EndNote><Cite><Author>West</Author><Year>2010</Year><RecNum>64</RecNum><DisplayText><style face="superscript">[7]</style></DisplayText><record><rec-number>64</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1563574004">64</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>West, J.</author><author>Card, T. R.</author></authors></contributors><auth-address>Division of Epidemiology and Public Health, Nottingham City Hospital, University of Nottingham, Nottingham, United Kingdom. joe.west@nottingham.ac.uk</auth-address><titles><title>Reduced mortality rates following elective percutaneous liver biopsies</title><secondary-title>Gastroenterology</secondary-title></titles><periodical><full-title>Gastroenterology</full-title></periodical><pages>1230-7</pages><volume>139</volume><number>4</number><edition>2010/06/16</edition><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Biopsy/adverse effects/*mortality</keyword><keyword>Female</keyword><keyword>Hemorrhage/epidemiology</keyword><keyword>Humans</keyword><keyword>Liver/*pathology</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword></keywords><dates><year>2010</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1528-0012 (Electronic)
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ADDIN EN.CITE.DATA [8,9]. Further, the use of PCLB and TJLB may have substantial variation in histologic yield ADDIN EN.CITE <EndNote><Cite><Author>Regev</Author><Year>2002</Year><RecNum>67</RecNum><DisplayText><style face="superscript">[10]</style></DisplayText><record><rec-number>67</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1563574812">67</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Regev, A.</author><author>Berho, M.</author><author>Jeffers, L. J.</author><author>Milikowski, C.</author><author>Molina, E. G.</author><author>Pyrsopoulos, N. T.</author><author>Feng, Z. Z.</author><author>Reddy, K. R.</author><author>Schiff, E. R.</author></authors></contributors><auth-address>Division of Hepatology, Center for Liver Diseases, University of Miami School of Medicine, Florida 33136, USA.</auth-address><titles><title>Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection</title><secondary-title>Am J Gastroenterol</secondary-title></titles><periodical><full-title>Am J Gastroenterol</full-title></periodical><pages>2614-8</pages><volume>97</volume><number>10</number><edition>2002/10/19</edition><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>*Biopsy, Needle</keyword><keyword>Female</keyword><keyword>Fibrosis</keyword><keyword>Hepatitis C, Chronic/*pathology</keyword><keyword>Humans</keyword><keyword>Inflammation</keyword><keyword>Liver/*pathology</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Observer Variation</keyword><keyword>Specimen Handling</keyword></keywords><dates><year>2002</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>0002-9270 (Print)
0002-9270 (Linking)</isbn><accession-num>12385448</accession-num><urls><related-urls><url>;[10].Endoscopic US guided LB (EUS-LB) is a sampling technique that has surfaced as an effective alternative to traditional methods of obtaining liver tissue both for focal and parenchymal disease ADDIN EN.CITE <EndNote><Cite><Author>Shah</Author><Year>2019</Year><RecNum>9</RecNum><DisplayText><style face="superscript">[11]</style></DisplayText><record><rec-number>9</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561073012">9</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shah, A. R.</author><author>Al-Hanayneh, M.</author><author>Chowdhry, M.</author><author>Bilal, M.</author><author>Singh, S.</author></authors></contributors><auth-address>Department of Internal Medicine, MetroHealth Medical Center, Cleveland, OH 44109, United States.
Division of Gastroenterology and Hepatology, the University of Texas Medical Branch, Galveston, TX 77555, United States.
Division of Gastroenterology, Department of Internal Medicine, West Virginia University, Charleston, WV 25304, United States.
Division of Gastroenterology, Department of Internal Medicine, West Virginia University, Charleston, WV 25304, United States. shail121@.</auth-address><titles><title>Endoscopic ultrasound guided liver biopsy for parenchymal liver disease</title><secondary-title>World J Hepatol</secondary-title></titles><periodical><full-title>World J Hepatol</full-title></periodical><pages>335-343</pages><volume>11</volume><number>4</number><edition>2019/05/23</edition><keywords><keyword>Endoscopic ultrasound</keyword><keyword>Endoscopic ultrasound guided liver biopsy</keyword><keyword>Liver biopsy</keyword><keyword>Liver disease</keyword><keyword>have no financial disclosures with respect to this manuscript.</keyword></keywords><dates><year>2019</year><pub-dates><date>Apr 27</date></pub-dates></dates><isbn>1948-5182 (Print)</isbn><accession-num>31114638</accession-num><urls><related-urls><url>;[11]. In addition to an improved safety profile, EUS-LB presents numerous advantages over PC and TJ routes of biopsy. Briefly, EUS-LB allows for higher quality images of both hepatic lobes, which allows for a safer biopsy technique and improved ability to access focal liver lesions ADDIN EN.CITE <EndNote><Cite><Author>Saraireh</Author><Year>2017</Year><RecNum>6</RecNum><DisplayText><style face="superscript">[12]</style></DisplayText><record><rec-number>6</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561067750">6</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Saraireh, H. A.</author><author>Bilal, M.</author><author>Singh, S.</author></authors></contributors><auth-address>Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, United States.
Division of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, TX 77555, United States.
Division of Gastroenterology, Hepatology and Nutrition, Allegheny General Hospital, Pittsburgh, PA 15212, United States. shail121@.</auth-address><titles><title>Role of endoscopic ultrasound in liver disease: Where do we stand in 2017?</title><secondary-title>World J Hepatol</secondary-title></titles><periodical><full-title>World J Hepatol</full-title></periodical><pages>1013-1021</pages><volume>9</volume><number>24</number><edition>2017/09/22</edition><keywords><keyword>Endoscopic ultrasound</keyword><keyword>Liver disease</keyword><keyword>Liver lesions</keyword><keyword>Portal hypertension</keyword><keyword>have no financial disclosures.</keyword></keywords><dates><year>2017</year><pub-dates><date>Aug 28</date></pub-dates></dates><isbn>1948-5182 (Print)</isbn><accession-num>28932347</accession-num><urls><related-urls><url>;[12]. Additionally, EUS-LB is conducted under sedation, allowing for reduced procedural anxiety and increased patient comfort ADDIN EN.CITE <EndNote><Cite><Author>Diehl</Author><Year>2019</Year><RecNum>10</RecNum><DisplayText><style face="superscript">[13]</style></DisplayText><record><rec-number>10</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561073315">10</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Diehl, D. L.</author></authors></contributors><auth-address>Department of Gastroenterology and Nutrition, Geisinger Medical Center, 100 North Academy Avenue, 21-11, Danville, PA 17822, USA. Electronic address: dldiehl@geisinger.edu.</auth-address><titles><title>Endoscopic Ultrasound-guided Liver Biopsy</title><secondary-title>Gastrointest Endosc Clin N Am</secondary-title></titles><periodical><full-title>Gastrointest Endosc Clin N Am</full-title></periodical><pages>173-186</pages><volume>29</volume><number>2</number><edition>2019/03/09</edition><keywords><keyword>Abnormal liver tests</keyword><keyword>Cirrhosis</keyword><keyword>Core biopsy</keyword><keyword>Fine-needle aspiration</keyword><keyword>Fine-needle biopsy</keyword><keyword>Hepatic fibrosis</keyword><keyword>Liver biopsy</keyword></keywords><dates><year>2019</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1558-1950 (Electronic)
1052-5157 (Linking)</isbn><accession-num>30846147</accession-num><urls><related-urls><url>;[13]. Ultimately, the decision on the route of tissue acquisition largely relies upon the indications for the LB, the patient risk profile and the experience of the endoscopist, including the procedural volumes. Given the superiority of EUS-LB in various aspects, this article aims to provide an update on the emerging evidence, indications, technique, advantages, and complications. This will ultimately help physicians determine the most appropriate method of LB.INDICATIONS FOR LBThe use of imaging, including newer modalities like transient elastography and serology, has helped decrease the need for LBs. For instance, in a patient with established cirrhosis, a solid liver lesion with certain characteristics on magnetic resonance imaging and compatible tumor markers, the diagnosis is presumably hepatocellular carcinoma and would not necessarily require a LB ADDIN EN.CITE <EndNote><Cite><Author>Stolzel</Author><Year>2000</Year><RecNum>97</RecNum><DisplayText><style face="superscript">[14]</style></DisplayText><record><rec-number>97</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1564743216">97</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Stolzel, U.</author><author>Tannapfel, A.</author></authors></contributors><auth-address>Abteilung fur Innere Medizin, Gastroenterologie und Infektiologie, Dr. Drogula GmbH, Krankenhaus Dobeln. ulrichstoelzel@t-online.de</auth-address><titles><title>[Indications for liver biopsy in liver tumors]</title><secondary-title>Zentralbl Chir</secondary-title></titles><periodical><full-title>Zentralbl Chir</full-title></periodical><pages>606-9</pages><volume>125</volume><number>7</number><edition>2000/08/29</edition><keywords><keyword>*Biopsy, Needle/adverse effects/methods</keyword><keyword>Carcinoma, Hepatocellular/diagnosis/*pathology</keyword><keyword>Diagnosis, Differential</keyword><keyword>Hemochromatosis/complications/genetics/pathology</keyword><keyword>Histocompatibility Antigens Class I/genetics</keyword><keyword>Humans</keyword><keyword>Liver/*pathology</keyword><keyword>Liver Cirrhosis/diagnosis/pathology</keyword><keyword>Liver Diseases/diagnosis/pathology</keyword><keyword>Liver Neoplasms/diagnosis/*pathology</keyword><keyword>Mutation</keyword><keyword>Sensitivity and Specificity</keyword></keywords><dates><year>2000</year></dates><orig-pub>Indikationen zur Leberbiopsie bei Lebertumoren.</orig-pub><isbn>0044-409X (Print)
0044-409X (Linking)</isbn><accession-num>10960970</accession-num><urls><related-urls><url>;[14]. Similarly, in cases in which a liver lesion is most likely related to metastasis from a proven primary cancer, biopsy may not be indicated unless there is enough evidence to the contrary or tissue is needed for diagnostic confirmation or workup for specialized molecular tests ADDIN EN.CITE <EndNote><Cite><Author>Stolzel</Author><Year>2000</Year><RecNum>97</RecNum><DisplayText><style face="superscript">[14]</style></DisplayText><record><rec-number>97</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1564743216">97</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Stolzel, U.</author><author>Tannapfel, A.</author></authors></contributors><auth-address>Abteilung fur Innere Medizin, Gastroenterologie und Infektiologie, Dr. Drogula GmbH, Krankenhaus Dobeln. ulrichstoelzel@t-online.de</auth-address><titles><title>[Indications for liver biopsy in liver tumors]</title><secondary-title>Zentralbl Chir</secondary-title></titles><periodical><full-title>Zentralbl Chir</full-title></periodical><pages>606-9</pages><volume>125</volume><number>7</number><edition>2000/08/29</edition><keywords><keyword>*Biopsy, Needle/adverse effects/methods</keyword><keyword>Carcinoma, Hepatocellular/diagnosis/*pathology</keyword><keyword>Diagnosis, Differential</keyword><keyword>Hemochromatosis/complications/genetics/pathology</keyword><keyword>Histocompatibility Antigens Class I/genetics</keyword><keyword>Humans</keyword><keyword>Liver/*pathology</keyword><keyword>Liver Cirrhosis/diagnosis/pathology</keyword><keyword>Liver Diseases/diagnosis/pathology</keyword><keyword>Liver Neoplasms/diagnosis/*pathology</keyword><keyword>Mutation</keyword><keyword>Sensitivity and Specificity</keyword></keywords><dates><year>2000</year></dates><orig-pub>Indikationen zur Leberbiopsie bei Lebertumoren.</orig-pub><isbn>0044-409X (Print)
0044-409X (Linking)</isbn><accession-num>10960970</accession-num><urls><related-urls><url>;[14]. However, there are?several clinical?scenarios that warrant LB. One of the most common utilities of LB is diagnosing the etiology of complex liver disease that cannot be reasonably identified by imaging, serology or laboratory values ADDIN EN.CITE <EndNote><Cite><Author>Stolzel</Author><Year>2000</Year><RecNum>97</RecNum><DisplayText><style face="superscript">[14]</style></DisplayText><record><rec-number>97</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1564743216">97</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Stolzel, U.</author><author>Tannapfel, A.</author></authors></contributors><auth-address>Abteilung fur Innere Medizin, Gastroenterologie und Infektiologie, Dr. Drogula GmbH, Krankenhaus Dobeln. ulrichstoelzel@t-online.de</auth-address><titles><title>[Indications for liver biopsy in liver tumors]</title><secondary-title>Zentralbl Chir</secondary-title></titles><periodical><full-title>Zentralbl Chir</full-title></periodical><pages>606-9</pages><volume>125</volume><number>7</number><edition>2000/08/29</edition><keywords><keyword>*Biopsy, Needle/adverse effects/methods</keyword><keyword>Carcinoma, Hepatocellular/diagnosis/*pathology</keyword><keyword>Diagnosis, Differential</keyword><keyword>Hemochromatosis/complications/genetics/pathology</keyword><keyword>Histocompatibility Antigens Class I/genetics</keyword><keyword>Humans</keyword><keyword>Liver/*pathology</keyword><keyword>Liver Cirrhosis/diagnosis/pathology</keyword><keyword>Liver Diseases/diagnosis/pathology</keyword><keyword>Liver Neoplasms/diagnosis/*pathology</keyword><keyword>Mutation</keyword><keyword>Sensitivity and Specificity</keyword></keywords><dates><year>2000</year></dates><orig-pub>Indikationen zur Leberbiopsie bei Lebertumoren.</orig-pub><isbn>0044-409X (Print)
0044-409X (Linking)</isbn><accession-num>10960970</accession-num><urls><related-urls><url>;[14]. LB can also useful in distinguishing cases where there are disease processes that overlap such as in autoimmune hepatitis and drug induced liver injury ADDIN EN.CITE <EndNote><Cite><Author>Suzuki</Author><Year>2011</Year><RecNum>148</RecNum><DisplayText><style face="superscript">[15]</style></DisplayText><record><rec-number>148</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1568595818">148</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Suzuki, A.</author><author>Brunt, E. M.</author><author>Kleiner, D. E.</author><author>Miquel, R.</author><author>Smyrk, T. C.</author><author>Andrade, R. J.</author><author>Lucena, M. I.</author><author>Castiella, A.</author><author>Lindor, K.</author><author>Bjornsson, E.</author></authors></contributors><auth-address>Division of Gastroenterology, Duke University Medical Center, Durham, NC 27710, USA. suzuk004@mc.duke.edu</auth-address><titles><title>The use of liver biopsy evaluation in discrimination of idiopathic autoimmune hepatitis versus drug-induced liver injury</title><secondary-title>Hepatology</secondary-title></titles><periodical><full-title>Hepatology</full-title></periodical><pages>931-9</pages><volume>54</volume><number>3</number><edition>2011/06/16</edition><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Biopsy</keyword><keyword>Chemical and Drug Induced Liver Injury/*pathology</keyword><keyword>Female</keyword><keyword>Hepatitis, Autoimmune/*pathology</keyword><keyword>Humans</keyword><keyword>Liver/*pathology</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword></keywords><dates><year>2011</year><pub-dates><date>Sep 2</date></pub-dates></dates><isbn>1527-3350 (Electronic)
0270-9139 (Linking)</isbn><accession-num>21674554</accession-num><urls><related-urls><url>;[15]. Additionally, LBs are essential to establishing a diagnosis and staging of diseases such as nonalcoholic steatohepatitis (NASH), chronic liver disease due to hepatitis B and C, autoimmune hepatitis, and acute liver failure of indeterminate etiology, amongst other liver diseases ADDIN EN.CITE <EndNote><Cite><Author>Tannapfel</Author><Year>2012</Year><RecNum>94</RecNum><DisplayText><style face="superscript">[16]</style></DisplayText><record><rec-number>94</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1564742389">94</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Tannapfel, A.</author><author>Dienes, H. P.</author><author>Lohse, A. W.</author></authors></contributors><auth-address>Institute of Pathology, Ruhr-University Bochum, Germany. Andrea.Tannapfel@rub.de</auth-address><titles><title>The indications for liver biopsy</title><secondary-title>Dtsch Arztebl Int</secondary-title></titles><periodical><full-title>Dtsch Arztebl Int</full-title></periodical><pages>477-83</pages><volume>109</volume><number>27-28</number><edition>2012/07/27</edition><keywords><keyword>Biopsy, Needle/statistics & numerical data</keyword><keyword>Diagnosis, Differential</keyword><keyword>Humans</keyword><keyword>Liver Diseases/*epidemiology/*pathology</keyword><keyword>Prevalence</keyword><keyword>Reproducibility of Results</keyword><keyword>Sensitivity and Specificity</keyword></keywords><dates><year>2012</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1866-0452 (Electronic)
1866-0452 (Linking)</isbn><accession-num>22833761</accession-num><urls><related-urls><url>;[16]. LB can also help diagnose systemic diseases, such as amyloidosis and sarcoidosis, that can affect the liver and assist in the work up of pyrexia of unknown originPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CcmF2bzwvQXV0aG9yPjxZZWFyPjIwMDE8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [1,16].LBs can be crucial to assessing disease severity and establishing prognosis. While serology is useful to establish a diagnosis of viral hepatitis, the LB helps to quantify the extent of inflammation or fibrosis, as well as identification of concomitant disease processes, which may have significant prognostic implications ADDIN EN.CITE <EndNote><Cite><Author>Tannapfel</Author><Year>2012</Year><RecNum>94</RecNum><DisplayText><style face="superscript">[16]</style></DisplayText><record><rec-number>94</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1564742389">94</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Tannapfel, A.</author><author>Dienes, H. P.</author><author>Lohse, A. W.</author></authors></contributors><auth-address>Institute of Pathology, Ruhr-University Bochum, Germany. Andrea.Tannapfel@rub.de</auth-address><titles><title>The indications for liver biopsy</title><secondary-title>Dtsch Arztebl Int</secondary-title></titles><periodical><full-title>Dtsch Arztebl Int</full-title></periodical><pages>477-83</pages><volume>109</volume><number>27-28</number><edition>2012/07/27</edition><keywords><keyword>Biopsy, Needle/statistics & numerical data</keyword><keyword>Diagnosis, Differential</keyword><keyword>Humans</keyword><keyword>Liver Diseases/*epidemiology/*pathology</keyword><keyword>Prevalence</keyword><keyword>Reproducibility of Results</keyword><keyword>Sensitivity and Specificity</keyword></keywords><dates><year>2012</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1866-0452 (Electronic)
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ADDIN EN.CITE.DATA [16,17]. Transient elastography techniques have decreased the need for LB in deciding on treatment options in many conditions like chronic viral hepatitis. With the availability of directly acting antivirals for treatment of chronic hepatitis C infection, fibrosis staging is most of the time performed using transient elastography. But in chronic viral hepatitis and many other hepatitis diseases like auotoimmune hepatitits, alcoholic and non alcoholic steatohepatitis, assessment of grade of activity can be accomplished only by LB. Distinguising some of the rare conditions like nodular regenerative hyperplasis from cirrhosis can be accomplished only with LB[2,16].METHODS OF LBThe methods of LB are mainly categorized into three groups including traditional methods, surgical based, and EUS-guided approaches. Each method has its own pros and cons as summarized in Table 1. Traditional methods of acquiring LBPCLB: The earliest known PC biopsy of the liver was conducted in the early 1900s and has since remained the primary method of sampling liver tissue ADDIN EN.CITE <EndNote><Cite><Author>Pelz</Author><Year>1965</Year><RecNum>62</RecNum><DisplayText><style face="superscript">[18]</style></DisplayText><record><rec-number>62</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1563346646">62</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Pelz, L.</author></authors></contributors><titles><title>[Diagnostic liver puncture in the work of Paul Ehrlich]</title><secondary-title>Med Monatsschr</secondary-title></titles><periodical><full-title>Med Monatsschr</full-title></periodical><pages>357-9</pages><volume>19</volume><number>8</number><edition>1965/08/01</edition><keywords><keyword>Biopsy/*history</keyword><keyword>Germany</keyword><keyword>History of Medicine</keyword><keyword>Liver Diseases/*diagnosis</keyword></keywords><dates><year>1965</year><pub-dates><date>Aug</date></pub-dates></dates><orig-pub>Die diagnostische Leberpunktion im Schaffen Paul Ehrlichs.</orig-pub><isbn>0025-8474 (Print)
0025-8474 (Linking)</isbn><accession-num>5326954</accession-num><urls><related-urls><url>;[18]. In the PCLB method, a biopsy site is pinpointed over the liver, an incision is made in the skin aseptically under local anesthesia, and a needle is inserted into the liver to obtain a tissue sample ADDIN EN.CITE <EndNote><Cite><Author>Parekh</Author><Year>2015</Year><RecNum>44</RecNum><DisplayText><style face="superscript">[19]</style></DisplayText><record><rec-number>44</rec-number><foreign-keys><key app="EN" db-id="zwxrffpdpx00a7e5ddvp2tpctadrwr5dsd0p" timestamp="1563133674">44</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Parekh, P. J.</author><author>Majithia, R.</author><author>Diehl, D. L.</author><author>Baron, T. H.</author></authors></contributors><auth-address>Department of Internal Medicine, Division of Gastroenterology and Hepatology, Tulane University, New Orleans, Louisiana, USA.
Division of Gastroenterology and Hepatology, University of North Carolina - Johnston Healthcare, Smithfield, USA.
Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA.
Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA.</auth-address><titles><title>Endoscopic ultrasound-guided liver biopsy</title><secondary-title>Endosc Ultrasound</secondary-title></titles><periodical><full-title>Endosc Ultrasound</full-title></periodical><pages>85-91</pages><volume>4</volume><number>2</number><edition>2015/05/29</edition><keywords><keyword>EUS-guided liver biopsy (EUS-LB)</keyword><keyword>Endoscopic ultrasound (EUS)</keyword><keyword>Tru-Cut biopsy</keyword><keyword>fine needle biopsy</keyword><keyword>liver biopsy</keyword><keyword>nonalcoholic fatty liver disease (NAFLD)</keyword><keyword>nonalcoholic steatohepatitis (NASH)</keyword></keywords><dates><year>2015</year><pub-dates><date>Apr-Jun</date></pub-dates></dates><isbn>2303-9027 (Print)
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ADDIN EN.CITE.DATA [20]. However, this is now performed under CT or ultrasonographic guidance, minimizing adverse events ADDIN EN.CITE <EndNote><Cite><Author>Abdi</Author><Year>1979</Year><RecNum>28</RecNum><DisplayText><style face="superscript">[21]</style></DisplayText><record><rec-number>28</rec-number><foreign-keys><key app="EN" db-id="zwxrffpdpx00a7e5ddvp2tpctadrwr5dsd0p" timestamp="1561227457">28</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Abdi, W.</author><author>Millan, J. C.</author><author>Mezey, E.</author></authors></contributors><titles><title>Sampling variability on percutaneous liver biopsy</title><secondary-title>Arch Intern Med</secondary-title></titles><periodical><full-title>Arch Intern Med</full-title></periodical><pages>667-9</pages><volume>139</volume><number>6</number><edition>1979/06/01</edition><keywords><keyword>*Biopsy, Needle</keyword><keyword>Fatty Liver/diagnosis/pathology</keyword><keyword>Hepatitis/diagnosis/pathology</keyword><keyword>Humans</keyword><keyword>Liver/*pathology</keyword><keyword>Liver Cirrhosis/diagnosis/pathology</keyword><keyword>Liver Diseases/*diagnosis/pathology</keyword><keyword>Liver Neoplasms/diagnosis/pathology</keyword></keywords><dates><year>1979</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>0003-9926 (Print)
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ADDIN EN.CITE.DATA [22,23]. While use of CT or US guided biopsy has helped to decrease inadvertent punctures of adjacent organs, complications still occur ADDIN EN.CITE <EndNote><Cite><Author>Caldwell</Author><Year>2010</Year><RecNum>58</RecNum><DisplayText><style face="superscript">[24]</style></DisplayText><record><rec-number>58</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1563316124">58</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Caldwell, S.</author><author>Northup, P. G.</author></authors></contributors><titles><title>Bleeding complication with liver biopsy: is it predictable?</title><secondary-title>Clin Gastroenterol Hepatol</secondary-title></titles><periodical><full-title>Clin Gastroenterol Hepatol</full-title></periodical><pages>826-9</pages><volume>8</volume><number>10</number><edition>2010/07/06</edition><keywords><keyword>Angiography</keyword><keyword>Arteries/surgery</keyword><keyword>Biopsy, Needle/*adverse effects</keyword><keyword>Female</keyword><keyword>Hemorrhage/*epidemiology/*prevention & control</keyword><keyword>Histocytochemistry</keyword><keyword>Humans</keyword><keyword>Liver Diseases/*diagnosis/pathology</keyword><keyword>Male</keyword><keyword>Microscopy</keyword><keyword>Middle Aged</keyword><keyword>Radiography, Abdominal</keyword><keyword>Risk Factors</keyword><keyword>Thrombocytopenia/complications</keyword><keyword>Tomography, X-Ray Computed</keyword></keywords><dates><year>2010</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1542-7714 (Electronic)
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ADDIN EN.CITE.DATA [22]. Minor complications occur in nearly a quarter of cases, the most common being pain at the site of biopsy ADDIN EN.CITE <EndNote><Cite><Author>Eisenberg</Author><Year>2003</Year><RecNum>29</RecNum><DisplayText><style face="superscript">[25]</style></DisplayText><record><rec-number>29</rec-number><foreign-keys><key app="EN" db-id="zwxrffpdpx00a7e5ddvp2tpctadrwr5dsd0p" timestamp="1561232537">29</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Eisenberg, E.</author><author>Konopniki, M.</author><author>Veitsman, E.</author><author>Kramskay, R.</author><author>Gaitini, D.</author><author>Baruch, Y.</author></authors></contributors><auth-address>Pain Relief Unit, Rambam Medical Center, Haifa, Israel. e_eisenberg@rambam..il</auth-address><titles><title>Prevalence and characteristics of pain induced by percutaneous liver biopsy</title><secondary-title>Anesth Analg</secondary-title></titles><periodical><full-title>Anesth Analg</full-title></periodical><pages>1392-6, table of contents</pages><volume>96</volume><number>5</number><edition>2003/04/23</edition><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Anesthetics, Local/administration & dosage/therapeutic use</keyword><keyword>Anti-Anxiety Agents/therapeutic use</keyword><keyword>Anxiety/drug therapy/psychology</keyword><keyword>Biopsy/*adverse effects</keyword><keyword>Diazepam/therapeutic use</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Lidocaine/administration & dosage/therapeutic use</keyword><keyword>Liver/*pathology</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Pain/*epidemiology/etiology</keyword><keyword>Pain Measurement</keyword><keyword>Prospective Studies</keyword><keyword>Surveys and Questionnaires</keyword></keywords><dates><year>2003</year><pub-dates><date>May</date></pub-dates></dates><isbn>0003-2999 (Print)
0003-2999 (Linking)</isbn><accession-num>12707140</accession-num><urls><related-urls><url>;[25]. Other reported complications include peritonitis ADDIN EN.CITE <EndNote><Cite><Author>Veneri</Author><Year>1989</Year><RecNum>33</RecNum><DisplayText><style face="superscript">[26]</style></DisplayText><record><rec-number>33</rec-number><foreign-keys><key app="EN" db-id="zwxrffpdpx00a7e5ddvp2tpctadrwr5dsd0p" timestamp="1561232925">33</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Veneri, R. J.</author><author>Gordon, S. C.</author><author>Fink-Bennett, D.</author></authors></contributors><auth-address>Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan 48072.</auth-address><titles><title>Scintigraphic and culdoscopic diagnosis of bile peritonitis complicating liver biopsy</title><secondary-title>J Clin Gastroenterol</secondary-title></titles><periodical><full-title>J Clin Gastroenterol</full-title></periodical><pages>571-3</pages><volume>11</volume><number>5</number><edition>1989/10/01</edition><keywords><keyword>Adult</keyword><keyword>*Bile</keyword><keyword>Biliary Tract/diagnostic imaging</keyword><keyword>Biopsy, Needle/*adverse effects</keyword><keyword>Culdoscopy</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Liver/*pathology</keyword><keyword>Peritonitis/*diagnosis/etiology</keyword><keyword>Radionuclide Imaging</keyword></keywords><dates><year>1989</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>0192-0790 (Print)
0192-0790 (Linking)</isbn><accession-num>2794437</accession-num><urls><related-urls><url>;[26], hypotension ADDIN EN.CITE <EndNote><Cite><Author>Janes</Author><Year>1993</Year><RecNum>30</RecNum><DisplayText><style face="superscript">[27]</style></DisplayText><record><rec-number>30</rec-number><foreign-keys><key app="EN" db-id="zwxrffpdpx00a7e5ddvp2tpctadrwr5dsd0p" timestamp="1561232663">30</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Janes, C. H.</author><author>Lindor, K. D.</author></authors></contributors><auth-address>Mayo Foundation, Rochester, MN.</auth-address><titles><title>Outcome of patients hospitalized for complications after outpatient liver biopsy</title><secondary-title>Ann Intern Med</secondary-title></titles><periodical><full-title>Ann Intern Med</full-title></periodical><pages>96-8</pages><volume>118</volume><number>2</number><edition>1993/01/15</edition><keywords><keyword>Ambulatory Care</keyword><keyword>Biopsy, Needle/*adverse effects/methods</keyword><keyword>Hemoglobins/metabolism</keyword><keyword>Hospitalization</keyword><keyword>Humans</keyword><keyword>Hypotension, Orthostatic/etiology</keyword><keyword>Liver/*pathology</keyword><keyword>Male</keyword><keyword>Minnesota</keyword><keyword>Outcome Assessment (Health Care)</keyword><keyword>Pain/etiology</keyword><keyword>Retrospective Studies</keyword></keywords><dates><year>1993</year><pub-dates><date>Jan 15</date></pub-dates></dates><isbn>0003-4819 (Print)
0003-4819 (Linking)</isbn><accession-num>8416324</accession-num><urls><related-urls><url>;[27], infection, gallbladder perforation ADDIN EN.CITE <EndNote><Cite><Author>Gambarin-Gelwan</Author><Year>2006</Year><RecNum>60</RecNum><DisplayText><style face="superscript">[28]</style></DisplayText><record><rec-number>60</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1563572090">60</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gambarin-Gelwan, M.</author></authors></contributors><auth-address>Assistant Professor of Medicine Weill Medical College Cornell University.</auth-address><titles><title>Percutaneous Liver Biopsy</title><secondary-title>Gastroenterol Hepatol (N Y)</secondary-title></titles><periodical><full-title>Gastroenterol Hepatol (N Y)</full-title></periodical><pages>689-690</pages><volume>2</volume><number>9</number><edition>2006/09/01</edition><dates><year>2006</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>1554-7914 (Print)
1554-7914 (Linking)</isbn><accession-num>28316539</accession-num><urls><related-urls><url>;[28], pneumothorax or hemothorax ADDIN EN.CITE <EndNote><Cite><Author>Chahal</Author><Year>2002</Year><RecNum>34</RecNum><DisplayText><style face="superscript">[29]</style></DisplayText><record><rec-number>34</rec-number><foreign-keys><key app="EN" db-id="zwxrffpdpx00a7e5ddvp2tpctadrwr5dsd0p" timestamp="1561233222">34</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chahal, P. S.</author><author>Ready, J.</author></authors></contributors><titles><title>Hemothorax after percutaneous liver biopsy: an unusual complication</title><secondary-title>Am J Gastroenterol</secondary-title></titles><periodical><full-title>Am J Gastroenterol</full-title></periodical><pages>1068-9</pages><volume>97</volume><number>4</number><edition>2002/05/11</edition><keywords><keyword>Aged</keyword><keyword>Biopsy, Needle/*adverse effects</keyword><keyword>Female</keyword><keyword>Hemothorax/*etiology</keyword><keyword>Humans</keyword><keyword>Liver/*pathology</keyword><keyword>*Postoperative Complications</keyword></keywords><dates><year>2002</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>0002-9270 (Print)
0002-9270 (Linking)</isbn><accession-num>12003398</accession-num><urls><related-urls><url>;[29], transient bacteremia ADDIN EN.CITE <EndNote><Cite><Author>Sheth</Author><Year>2009</Year><RecNum>35</RecNum><DisplayText><style face="superscript">[30]</style></DisplayText><record><rec-number>35</rec-number><foreign-keys><key app="EN" db-id="zwxrffpdpx00a7e5ddvp2tpctadrwr5dsd0p" timestamp="1561233311">35</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sheth, D.</author><author>Pillai, A.</author><author>Ferral, H.</author><author>Madassery, S.</author></authors></contributors><auth-address>Department of Interventional Radiology, Rush University Medical Center, 1653 West Congress Parkway, Chicago, Illinois 60612, USA. dsheth2@</auth-address><titles><title>Transient bacteremia after a percutaneous liver biopsy</title><secondary-title>J Vasc Interv Radiol</secondary-title></titles><periodical><full-title>J Vasc Interv Radiol</full-title></periodical><pages>1429-30</pages><volume>20</volume><number>11</number><edition>2009/10/31</edition><keywords><keyword>Bacteremia/*diagnostic imaging/*etiology/prevention & control</keyword><keyword>Biopsy/*adverse effects</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Liver/*pathology</keyword><keyword>Middle Aged</keyword><keyword>Radiography</keyword></keywords><dates><year>2009</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>1535-7732 (Electronic)
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ADDIN EN.CITE.DATA [7,31]. Advantages/disadvantages of PCLB: One of the advantages to employing the PCLB method is that operators are more familiar with this method and have a better understanding of this technique and of the specimen. Thus, compared to newer methods, this is comparatively easier to use and demands less technical skill ADDIN EN.CITE <EndNote><Cite><Author>Shah</Author><Year>2019</Year><RecNum>9</RecNum><DisplayText><style face="superscript">[11]</style></DisplayText><record><rec-number>9</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561073012">9</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shah, A. R.</author><author>Al-Hanayneh, M.</author><author>Chowdhry, M.</author><author>Bilal, M.</author><author>Singh, S.</author></authors></contributors><auth-address>Department of Internal Medicine, MetroHealth Medical Center, Cleveland, OH 44109, United States.
Division of Gastroenterology and Hepatology, the University of Texas Medical Branch, Galveston, TX 77555, United States.
Division of Gastroenterology, Department of Internal Medicine, West Virginia University, Charleston, WV 25304, United States.
Division of Gastroenterology, Department of Internal Medicine, West Virginia University, Charleston, WV 25304, United States. shail121@.</auth-address><titles><title>Endoscopic ultrasound guided liver biopsy for parenchymal liver disease</title><secondary-title>World J Hepatol</secondary-title></titles><periodical><full-title>World J Hepatol</full-title></periodical><pages>335-343</pages><volume>11</volume><number>4</number><edition>2019/05/23</edition><keywords><keyword>Endoscopic ultrasound</keyword><keyword>Endoscopic ultrasound guided liver biopsy</keyword><keyword>Liver biopsy</keyword><keyword>Liver disease</keyword><keyword>have no financial disclosures with respect to this manuscript.</keyword></keywords><dates><year>2019</year><pub-dates><date>Apr 27</date></pub-dates></dates><isbn>1948-5182 (Print)</isbn><accession-num>31114638</accession-num><urls><related-urls><url>;[11]. Additionally, the PCLB route is cost effective, allowing for widespread use in various clinical settings. While the PC route is cost effective and well-known, several disadvantages exist ADDIN EN.CITE <EndNote><Cite><Author>Rockey</Author><Year>2009</Year><RecNum>4</RecNum><DisplayText><style face="superscript">[2]</style></DisplayText><record><rec-number>4</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561061673">4</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rockey, D. C.</author><author>Caldwell, S. H.</author><author>Goodman, Z. D.</author><author>Nelson, R. C.</author><author>Smith, A. D.</author><author>American Association for the Study of Liver, Diseases</author></authors></contributors><auth-address>Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX 75390-8887, USA. don.rockey@utsouthwestern.edu</auth-address><titles><title>Liver biopsy</title><secondary-title>Hepatology</secondary-title></titles><periodical><full-title>Hepatology</full-title></periodical><pages>1017-44</pages><volume>49</volume><number>3</number><edition>2009/02/27</edition><keywords><keyword>*Biopsy/adverse effects/methods</keyword><keyword>Contraindications</keyword><keyword>Humans</keyword><keyword>Liver/diagnostic imaging/*pathology</keyword><keyword>Liver Diseases/*diagnosis/pathology/physiopathology</keyword><keyword>Liver Function Tests</keyword><keyword>Radiography</keyword></keywords><dates><year>2009</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1527-3350 (Electronic)
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ADDIN EN.CITE.DATA [32,33].TJLB: Liver tissue can also be sampled via a TJ route, which was introduced in 1964 by Dotter ADDIN EN.CITE <EndNote><Cite><Author>Dotter</Author><Year>1964</Year><RecNum>81</RecNum><DisplayText><style face="superscript">[34]</style></DisplayText><record><rec-number>81</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1564147398">81</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Dotter, C. T.</author></authors></contributors><titles><title>Catheter Biopsy. Experimental Technic for Transvenous Liver Biopsy</title><secondary-title>Radiology</secondary-title></titles><periodical><full-title>Radiology</full-title></periodical><pages>312-4</pages><volume>82</volume><edition>1964/02/01</edition><keywords><keyword>Animals</keyword><keyword>*Biopsy</keyword><keyword>*Catheterization</keyword><keyword>*Catheters</keyword><keyword>Dogs</keyword><keyword>Humans</keyword><keyword>*Liver</keyword><keyword>*Radiography</keyword><keyword>*Research Design</keyword><keyword>*Surgical Equipment</keyword><keyword>*dogs</keyword></keywords><dates><year>1964</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0033-8419 (Print)
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ADDIN EN.CITE.DATA [36,39]. A retrospective study (n = 601) by Mammen et al ADDIN EN.CITE <EndNote><Cite><Author>Mammen</Author><Year>2008</Year><RecNum>71</RecNum><DisplayText><style face="superscript">[39]</style></DisplayText><record><rec-number>71</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1563979539">71</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mammen, T.</author><author>Keshava, S. N.</author><author>Eapen, C. E.</author><author>Raghuram, L.</author><author>Moses, V.</author><author>Gopi, K.</author><author>Babu, N. S.</author><author>Ramachandran, J.</author><author>Kurien, G.</author></authors></contributors><auth-address>Department of Radiology, Christian Medical College Hospital, Vellore, India. tom_mammen@yahoo.co.in</auth-address><titles><title>Transjugular liver biopsy: a retrospective analysis of 601 cases</title><secondary-title>J Vasc Interv Radiol</secondary-title></titles><periodical><full-title>J Vasc Interv Radiol</full-title></periodical><pages>351-8</pages><volume>19</volume><number>3</number><edition>2008/02/26</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Biopsy/*methods</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Jugular Veins</keyword><keyword>Liver/diagnostic imaging/*pathology</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Phlebography</keyword><keyword>Retrospective Studies</keyword><keyword>Ultrasonography</keyword></keywords><dates><year>2008</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1051-0443 (Print)
1051-0443 (Linking)</isbn><accession-num>18295693</accession-num><urls><related-urls><url>;[39] of patients who had undergone TJLB reported a 2.5% complication rate. Kalambokis et al ADDIN EN.CITE <EndNote><Cite><Author>Kalambokis</Author><Year>2007</Year><RecNum>1</RecNum><DisplayText><style face="superscript">[5]</style></DisplayText><record><rec-number>1</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561061457">1</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kalambokis, G.</author><author>Manousou, P.</author><author>Vibhakorn, S.</author><author>Marelli, L.</author><author>Cholongitas, E.</author><author>Senzolo, M.</author><author>Patch, D.</author><author>Burroughs, A. K.</author></authors></contributors><auth-address>The Sheila Sherlock Hepatobiliary Pancreatic and Liver Transplantation Unit, Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG, UK.</auth-address><titles><title>Transjugular liver biopsy--indications, adequacy, quality of specimens, and complications--a systematic review</title><secondary-title>J Hepatol</secondary-title></titles><periodical><full-title>J Hepatol</full-title></periodical><pages>284-94</pages><volume>47</volume><number>2</number><edition>2007/06/15</edition><keywords><keyword>Biopsy, Needle/adverse effects/*methods/standards</keyword><keyword>Humans</keyword><keyword>*Jugular Veins</keyword><keyword>Liver/*pathology</keyword></keywords><dates><year>2007</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0168-8278 (Print)
0168-8278 (Linking)</isbn><accession-num>17561303</accession-num><urls><related-urls><url>;[5] also conducted a large systematic review (7649 TJLBs) on TJLB and found an overall complication rate of 7.1%. Major complications following TJLB include pain and hemorrhage ADDIN EN.CITE <EndNote><Cite><Author>Behrens</Author><Year>2012</Year><RecNum>59</RecNum><DisplayText><style face="superscript">[36]</style></DisplayText><record><rec-number>59</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1563316594">59</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Behrens, G.</author><author>Ferral, H.</author></authors></contributors><auth-address>Section of Interventional Radiology, Department of Radiology and Nuclear Medicine, RUSH University Medical Center, Chicago, Illinois.</auth-address><titles><title>Transjugular liver biopsy</title><secondary-title>Semin Intervent Radiol</secondary-title></titles><periodical><full-title>Semin Intervent Radiol</full-title></periodical><pages>111-7</pages><volume>29</volume><number>2</number><edition>2013/06/05</edition><keywords><keyword>image-guided</keyword><keyword>interventional</keyword><keyword>liver biopsy</keyword><keyword>transjugular</keyword></keywords><dates><year>2012</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>0739-9529 (Print)
0739-9529 (Linking)</isbn><accession-num>23729981</accession-num><urls><related-urls><url>;[36]. An inherent risk of this method includes complications related to placement of the jugular catheter ADDIN EN.CITE <EndNote><Cite><Author>Tannapfel</Author><Year>2012</Year><RecNum>94</RecNum><DisplayText><style face="superscript">[16]</style></DisplayText><record><rec-number>94</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1564742389">94</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Tannapfel, A.</author><author>Dienes, H. P.</author><author>Lohse, A. W.</author></authors></contributors><auth-address>Institute of Pathology, Ruhr-University Bochum, Germany. Andrea.Tannapfel@rub.de</auth-address><titles><title>The indications for liver biopsy</title><secondary-title>Dtsch Arztebl Int</secondary-title></titles><periodical><full-title>Dtsch Arztebl Int</full-title></periodical><pages>477-83</pages><volume>109</volume><number>27-28</number><edition>2012/07/27</edition><keywords><keyword>Biopsy, Needle/statistics & numerical data</keyword><keyword>Diagnosis, Differential</keyword><keyword>Humans</keyword><keyword>Liver Diseases/*epidemiology/*pathology</keyword><keyword>Prevalence</keyword><keyword>Reproducibility of Results</keyword><keyword>Sensitivity and Specificity</keyword></keywords><dates><year>2012</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1866-0452 (Electronic)
1866-0452 (Linking)</isbn><accession-num>22833761</accession-num><urls><related-urls><url>;[16]. Other complications include inadequate sample size, hepatic hematoma, pyrexia, arrhythmias, abdominal pain, pneumo-thorax, haemobilia, carotid puncture, hypotension, capsular perforation, hepatic portal vein fistula and hepatic artery aneurysm ADDIN EN.CITE <EndNote><Cite><Author>Kalambokis</Author><Year>2007</Year><RecNum>26</RecNum><DisplayText><style face="superscript">[5]</style></DisplayText><record><rec-number>26</rec-number><foreign-keys><key app="EN" db-id="zwxrffpdpx00a7e5ddvp2tpctadrwr5dsd0p" timestamp="1561061375">26</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kalambokis, G.</author><author>Manousou, P.</author><author>Vibhakorn, S.</author><author>Marelli, L.</author><author>Cholongitas, E.</author><author>Senzolo, M.</author><author>Patch, D.</author><author>Burroughs, A. K.</author></authors></contributors><auth-address>The Sheila Sherlock Hepatobiliary Pancreatic and Liver Transplantation Unit, Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG, UK.</auth-address><titles><title>Transjugular liver biopsy--indications, adequacy, quality of specimens, and complications--a systematic review</title><secondary-title>J Hepatol</secondary-title></titles><periodical><full-title>J Hepatol</full-title></periodical><pages>284-94</pages><volume>47</volume><number>2</number><edition>2007/06/15</edition><keywords><keyword>Biopsy, Needle/adverse effects/*methods/standards</keyword><keyword>Humans</keyword><keyword>*Jugular Veins</keyword><keyword>Liver/*pathology</keyword></keywords><dates><year>2007</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0168-8278 (Print)
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ADDIN EN.CITE.DATA [2,32]Other advantages to the TJLB is its ability to be used in patients who have contraindications to PCLB. For example, this allows for assessment of liver disease in patients with coagulopathy and acute liver failure ADDIN EN.CITE <EndNote><Cite><Author>Saab</Author><Year>2004</Year><RecNum>108</RecNum><DisplayText><style face="superscript">[40]</style></DisplayText><record><rec-number>108</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1564793711">108</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Saab, S.</author><author>Cho, D.</author><author>Quon, D. V.</author><author>Ibrahim, A. B.</author><author>Dong, P.</author><author>Marder, V.</author><author>Logan, L.</author></authors></contributors><auth-address>Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. ssaab@mednet.ucla.edu</auth-address><titles><title>Same day outpatient transjugular liver biopsies in haemophilia</title><secondary-title>Haemophilia</secondary-title></titles><periodical><full-title>Haemophilia</full-title></periodical><pages>727-31</pages><volume>10</volume><number>6</number><edition>2004/12/01</edition><keywords><keyword>Adult</keyword><keyword>Ambulatory Surgical Procedures</keyword><keyword>Biopsy/methods</keyword><keyword>Factor IX/analysis</keyword><keyword>Factor VIII/analysis/therapeutic use</keyword><keyword>*Hemophilia A</keyword><keyword>Hepatitis C, Chronic/*diagnosis</keyword><keyword>Humans</keyword><keyword>Liver/*pathology</keyword><keyword>Male</keyword><keyword>Postoperative Complications/prevention & control</keyword></keywords><dates><year>2004</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>1351-8216 (Print)
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ADDIN EN.CITE.DATA [1,42]. Laparoscopy/laparotomyLaparoscopy or laparotomy represents another option for hepatic tissue acquisition that is typically used when a patient is already undergoing surgery for another indication and gross liver abnormalities are noted ADDIN EN.CITE <EndNote><Cite><Author>Denzer</Author><Year>2007</Year><RecNum>90</RecNum><DisplayText><style face="superscript">[43]</style></DisplayText><record><rec-number>90</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1564165850">90</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Denzer, U.</author><author>Arnoldy, A.</author><author>Kanzler, S.</author><author>Galle, P. R.</author><author>Dienes, H. P.</author><author>Lohse, A. W.</author></authors></contributors><auth-address>I Medical Department Johannes Gutenberg University Mainz, Mainz, Germany. u.denzer@uke.uni-hamburg.de</auth-address><titles><title>Prospective randomized comparison of minilaparoscopy and percutaneous liver biopsy: diagnosis of cirrhosis and complications</title><secondary-title>J Clin Gastroenterol</secondary-title></titles><periodical><full-title>J Clin Gastroenterol</full-title></periodical><pages>103-10</pages><volume>41</volume><number>1</number><edition>2007/01/02</edition><keywords><keyword>Adult</keyword><keyword>Biopsy/adverse effects/methods</keyword><keyword>Chronic Disease</keyword><keyword>Diagnosis, Differential</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Gastrointestinal Hemorrhage/*etiology</keyword><keyword>Humans</keyword><keyword>Laparoscopy/*adverse effects/*methods</keyword><keyword>Liver/*pathology</keyword><keyword>Liver Cirrhosis/*diagnosis</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Prognosis</keyword><keyword>Prospective Studies</keyword></keywords><dates><year>2007</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0192-0790 (Print)
0192-0790 (Linking)</isbn><accession-num>17198072</accession-num><urls><related-urls><url>;[43]. LBs undertaken with this approach are mostly done by wedge resection or cutting/aspiration needle. It is most useful in targeted biopsies of liver masses, staging tumors and in patients found to have inconclusive results using the PCLB or TJLB method ADDIN EN.CITE <EndNote><Cite><Author>Rockey</Author><Year>2009</Year><RecNum>4</RecNum><DisplayText><style face="superscript">[2]</style></DisplayText><record><rec-number>4</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561061673">4</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rockey, D. C.</author><author>Caldwell, S. H.</author><author>Goodman, Z. D.</author><author>Nelson, R. C.</author><author>Smith, A. D.</author><author>American Association for the Study of Liver, Diseases</author></authors></contributors><auth-address>Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX 75390-8887, USA. don.rockey@utsouthwestern.edu</auth-address><titles><title>Liver biopsy</title><secondary-title>Hepatology</secondary-title></titles><periodical><full-title>Hepatology</full-title></periodical><pages>1017-44</pages><volume>49</volume><number>3</number><edition>2009/02/27</edition><keywords><keyword>*Biopsy/adverse effects/methods</keyword><keyword>Contraindications</keyword><keyword>Humans</keyword><keyword>Liver/diagnostic imaging/*pathology</keyword><keyword>Liver Diseases/*diagnosis/pathology/physiopathology</keyword><keyword>Liver Function Tests</keyword><keyword>Radiography</keyword></keywords><dates><year>2009</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1527-3350 (Electronic)
0270-9139 (Linking)</isbn><accession-num>19243014</accession-num><urls><related-urls><url>;[2]. Complications: Adverse events following the surgical approach to LB include hemorrhage, abdominal wall injury, intraperitoneal injury and those related to use of anesthesia ADDIN EN.CITE <EndNote><Cite><Author>Rockey</Author><Year>2009</Year><RecNum>4</RecNum><DisplayText><style face="superscript">[2]</style></DisplayText><record><rec-number>4</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561061673">4</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rockey, D. C.</author><author>Caldwell, S. H.</author><author>Goodman, Z. D.</author><author>Nelson, R. C.</author><author>Smith, A. D.</author><author>American Association for the Study of Liver, Diseases</author></authors></contributors><auth-address>Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX 75390-8887, USA. don.rockey@utsouthwestern.edu</auth-address><titles><title>Liver biopsy</title><secondary-title>Hepatology</secondary-title></titles><periodical><full-title>Hepatology</full-title></periodical><pages>1017-44</pages><volume>49</volume><number>3</number><edition>2009/02/27</edition><keywords><keyword>*Biopsy/adverse effects/methods</keyword><keyword>Contraindications</keyword><keyword>Humans</keyword><keyword>Liver/diagnostic imaging/*pathology</keyword><keyword>Liver Diseases/*diagnosis/pathology/physiopathology</keyword><keyword>Liver Function Tests</keyword><keyword>Radiography</keyword></keywords><dates><year>2009</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1527-3350 (Electronic)
0270-9139 (Linking)</isbn><accession-num>19243014</accession-num><urls><related-urls><url>;[2].Advantages/disadvantages: One advantage to the surgical approach to LB is that it allows for ample tissue collection, and has an extremely high diagnostic tissue yield ADDIN EN.CITE <EndNote><Cite><Author>Denzer</Author><Year>2007</Year><RecNum>90</RecNum><DisplayText><style face="superscript">[43]</style></DisplayText><record><rec-number>90</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1564165850">90</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Denzer, U.</author><author>Arnoldy, A.</author><author>Kanzler, S.</author><author>Galle, P. R.</author><author>Dienes, H. P.</author><author>Lohse, A. W.</author></authors></contributors><auth-address>I Medical Department Johannes Gutenberg University Mainz, Mainz, Germany. u.denzer@uke.uni-hamburg.de</auth-address><titles><title>Prospective randomized comparison of minilaparoscopy and percutaneous liver biopsy: diagnosis of cirrhosis and complications</title><secondary-title>J Clin Gastroenterol</secondary-title></titles><periodical><full-title>J Clin Gastroenterol</full-title></periodical><pages>103-10</pages><volume>41</volume><number>1</number><edition>2007/01/02</edition><keywords><keyword>Adult</keyword><keyword>Biopsy/adverse effects/methods</keyword><keyword>Chronic Disease</keyword><keyword>Diagnosis, Differential</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Gastrointestinal Hemorrhage/*etiology</keyword><keyword>Humans</keyword><keyword>Laparoscopy/*adverse effects/*methods</keyword><keyword>Liver/*pathology</keyword><keyword>Liver Cirrhosis/*diagnosis</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Prognosis</keyword><keyword>Prospective Studies</keyword></keywords><dates><year>2007</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0192-0790 (Print)
0192-0790 (Linking)</isbn><accession-num>17198072</accession-num><urls><related-urls><url>;[43]. In a retrospective study of laparoscopic LBs by Vargas et al ADDIN EN.CITE <EndNote><Cite><Author>Vargas</Author><Year>1995</Year><RecNum>89</RecNum><DisplayText><style face="superscript">[44]</style></DisplayText><record><rec-number>89</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1564164998">89</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Vargas, C.</author><author>Jeffers, L. J.</author><author>Bernstein, D.</author><author>Reddy, K. R.</author><author>Munnangi, S.</author><author>Behar, S.</author><author>Scott, C.</author><author>Parker, T.</author><author>Schiff, E. R.</author></authors></contributors><auth-address>Center for Liver Diseases, University of Miami School of Medicine, Florida, USA.</auth-address><titles><title>Diagnostic laparoscopy: a 5-year experience in a hepatology training program</title><secondary-title>Am J Gastroenterol</secondary-title></titles><periodical><full-title>Am J Gastroenterol</full-title></periodical><pages>1258-62</pages><volume>90</volume><number>8</number><edition>1995/08/01</edition><keywords><keyword>Chronic Disease</keyword><keyword>*Education, Medical, Graduate</keyword><keyword>Gastroenterology/*education</keyword><keyword>Humans</keyword><keyword>Laparoscopy/adverse effects/*statistics & numerical data</keyword><keyword>Liver Diseases/*diagnosis/epidemiology</keyword><keyword>Middle Aged</keyword><keyword>Peritoneal Diseases/diagnosis/epidemiology</keyword><keyword>Retrospective Studies</keyword></keywords><dates><year>1995</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0002-9270 (Print)
0002-9270 (Linking)</isbn><accession-num>7639226</accession-num><urls><related-urls><url>;[44], a conclusive diagnosis of cirrhosis was made in 93 percent of 1794 cases. Additionally, the surgical approach allows for evaluation of the gross features of the liver, as well as other important peritoneal structures. Studies have shown that the added ability to grossly evaluate the liver allows for detection of up to 30% more cases of liver cirrhosis than with LB alone ADDIN EN.CITE <EndNote><Cite><Author>Poniachik</Author><Year>1996</Year><RecNum>98</RecNum><DisplayText><style face="superscript">[45]</style></DisplayText><record><rec-number>98</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1564743686">98</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Poniachik, J.</author><author>Bernstein, D. E.</author><author>Reddy, K. R.</author><author>Jeffers, L. J.</author><author>Coelho-Little, M. E.</author><author>Civantos, F.</author><author>Schiff, E. R.</author></authors></contributors><auth-address>Division of Hepatology, University of Miami School of Medicine, Florida, USA.</auth-address><titles><title>The role of laparoscopy in the diagnosis of cirrhosis</title><secondary-title>Gastrointest Endosc</secondary-title></titles><periodical><full-title>Gastrointest Endosc</full-title></periodical><pages>568-71</pages><volume>43</volume><number>6</number><edition>1996/06/01</edition><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Biopsy</keyword><keyword>Chronic Disease</keyword><keyword>False Negative Reactions</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Laparoscopy/*methods</keyword><keyword>Liver/pathology</keyword><keyword>Liver Cirrhosis/*diagnosis/etiology</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Predictive Value of Tests</keyword><keyword>Retrospective Studies</keyword><keyword>Sensitivity and Specificity</keyword></keywords><dates><year>1996</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>0016-5107 (Print)
0016-5107 (Linking)</isbn><accession-num>8781934</accession-num><urls><related-urls><url>(96)70192-x</electronic-resource-num></record></Cite></EndNote>[45]. Operators can also coagulate puncture sites immediately in the event of bile leakage or overt hemorrhage, which allows for LB in patients with higher risks of bleeding ADDIN EN.CITE <EndNote><Cite><Author>Lohse</Author><Year>2011</Year><RecNum>95</RecNum><DisplayText><style face="superscript">[46]</style></DisplayText><record><rec-number>95</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1564742698">95</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lohse, A. W.</author></authors></contributors><auth-address>Department of Medicine, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. ansgar-lohse@web.de, alohse@uke.de</auth-address><titles><title>Rolls Royce for everybody? Diagnosing liver disease by mini-laparoscopy</title><secondary-title>J Hepatol</secondary-title></titles><periodical><full-title>J Hepatol</full-title></periodical><pages>584-5</pages><volume>54</volume><number>3</number><edition>2010/12/17</edition><keywords><keyword>Carcinoma, Hepatocellular/diagnosis</keyword><keyword>Fatty Liver, Alcoholic/diagnosis/therapy</keyword><keyword>Female</keyword><keyword>Hepatitis C, Chronic/diagnosis/therapy</keyword><keyword>Humans</keyword><keyword>Laparoscopy/*methods</keyword><keyword>Liver Diseases/*diagnosis</keyword><keyword>Liver Neoplasms/diagnosis</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Minimally Invasive Surgical Procedures/methods</keyword></keywords><dates><year>2011</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1600-0641 (Electronic)
0168-8278 (Linking)</isbn><accession-num>21159402</accession-num><urls><related-urls><url>;[46]. A disadvantage to the surgical approach is that surgery is more invasive, hence limiting its use to patients who require surgery for some other indication. A laparoscopic LB can also be more expensive, further limiting its widespread routine use ADDIN EN.CITE <EndNote><Cite><Author>Rockey</Author><Year>2009</Year><RecNum>4</RecNum><DisplayText><style face="superscript">[2]</style></DisplayText><record><rec-number>4</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561061673">4</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rockey, D. C.</author><author>Caldwell, S. H.</author><author>Goodman, Z. D.</author><author>Nelson, R. C.</author><author>Smith, A. D.</author><author>American Association for the Study of Liver, Diseases</author></authors></contributors><auth-address>Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX 75390-8887, USA. don.rockey@utsouthwestern.edu</auth-address><titles><title>Liver biopsy</title><secondary-title>Hepatology</secondary-title></titles><periodical><full-title>Hepatology</full-title></periodical><pages>1017-44</pages><volume>49</volume><number>3</number><edition>2009/02/27</edition><keywords><keyword>*Biopsy/adverse effects/methods</keyword><keyword>Contraindications</keyword><keyword>Humans</keyword><keyword>Liver/diagnostic imaging/*pathology</keyword><keyword>Liver Diseases/*diagnosis/pathology/physiopathology</keyword><keyword>Liver Function Tests</keyword><keyword>Radiography</keyword></keywords><dates><year>2009</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1527-3350 (Electronic)
0270-9139 (Linking)</isbn><accession-num>19243014</accession-num><urls><related-urls><url>;[2]. EUS-LBEUS, developed in the late 1980s and refined in the 1990s, represents a more recent approach to acquiring hepatic tissue for histological analysisPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5GcmllZGJlcmc8L0F1dGhvcj48WWVhcj4yMDE3PC9ZZWFy
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ADDIN EN.CITE.DATA [47-49]. Ever since the availability of core biopsy needles, they have been used exclusively for EUS-LB, rather than conventional fine needles. The latter is currently utilized when cytology is sufficient and tissue architecture is not critical to diagnosis. In this approach, the left lobe of the liver is identified by the echo-endoscope from the stomach and the right lobe (Figure 1) from the duodenal bulb. With use of color doppler imaging, proper care is taken to ensure there are no vascular structures along the needle path ADDIN EN.CITE <EndNote><Cite><Author>Parekh</Author><Year>2015</Year><RecNum>44</RecNum><DisplayText><style face="superscript">[19]</style></DisplayText><record><rec-number>44</rec-number><foreign-keys><key app="EN" db-id="zwxrffpdpx00a7e5ddvp2tpctadrwr5dsd0p" timestamp="1563133674">44</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Parekh, P. J.</author><author>Majithia, R.</author><author>Diehl, D. L.</author><author>Baron, T. H.</author></authors></contributors><auth-address>Department of Internal Medicine, Division of Gastroenterology and Hepatology, Tulane University, New Orleans, Louisiana, USA.
Division of Gastroenterology and Hepatology, University of North Carolina - Johnston Healthcare, Smithfield, USA.
Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA.
Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA.</auth-address><titles><title>Endoscopic ultrasound-guided liver biopsy</title><secondary-title>Endosc Ultrasound</secondary-title></titles><periodical><full-title>Endosc Ultrasound</full-title></periodical><pages>85-91</pages><volume>4</volume><number>2</number><edition>2015/05/29</edition><keywords><keyword>EUS-guided liver biopsy (EUS-LB)</keyword><keyword>Endoscopic ultrasound (EUS)</keyword><keyword>Tru-Cut biopsy</keyword><keyword>fine needle biopsy</keyword><keyword>liver biopsy</keyword><keyword>nonalcoholic fatty liver disease (NAFLD)</keyword><keyword>nonalcoholic steatohepatitis (NASH)</keyword></keywords><dates><year>2015</year><pub-dates><date>Apr-Jun</date></pub-dates></dates><isbn>2303-9027 (Print)
2226-7190 (Linking)</isbn><accession-num>26020041</accession-num><urls><related-urls><url>;[19]. Commonly, a 19-G core biopsy needle is used to sample the left lobe followed by the right lobe ADDIN EN.CITE <EndNote><Cite><Author>Rockey</Author><Year>2009</Year><RecNum>4</RecNum><DisplayText><style face="superscript">[2]</style></DisplayText><record><rec-number>4</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561061673">4</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rockey, D. C.</author><author>Caldwell, S. H.</author><author>Goodman, Z. D.</author><author>Nelson, R. C.</author><author>Smith, A. D.</author><author>American Association for the Study of Liver, Diseases</author></authors></contributors><auth-address>Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX 75390-8887, USA. don.rockey@utsouthwestern.edu</auth-address><titles><title>Liver biopsy</title><secondary-title>Hepatology</secondary-title></titles><periodical><full-title>Hepatology</full-title></periodical><pages>1017-44</pages><volume>49</volume><number>3</number><edition>2009/02/27</edition><keywords><keyword>*Biopsy/adverse effects/methods</keyword><keyword>Contraindications</keyword><keyword>Humans</keyword><keyword>Liver/diagnostic imaging/*pathology</keyword><keyword>Liver Diseases/*diagnosis/pathology/physiopathology</keyword><keyword>Liver Function Tests</keyword><keyword>Radiography</keyword></keywords><dates><year>2009</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>1527-3350 (Electronic)
0270-9139 (Linking)</isbn><accession-num>19243014</accession-num><urls><related-urls><url>;[2]. Adverse events/complications: EUS-LB is generally safe, with few adverse events reported in the literature (Table 2). In a meta-analysis of studies (n = 437) reporting on EUS-LB, the rate of adverse events was 2.3%, with minor bleeding as the primary complication ADDIN EN.CITE <EndNote><Cite><Author>Mohan</Author><Year>2019</Year><RecNum>23</RecNum><DisplayText><style face="superscript">[50]</style></DisplayText><record><rec-number>23</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561144670">23</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mohan, B. P.</author><author>Shakhatreh, M.</author><author>Garg, R.</author><author>Ponnada, S.</author><author>Adler, D. G.</author></authors></contributors><auth-address>University of Alabama, DCH Medical Center, Tuscaloosa, Alabama, USA.
Rapides Regional Medical Center, Alexandria, Louisiana, USA.
Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Carilion Roanoke Memorial Hospital, Roanoke, Virginia, USA.
Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA.</auth-address><titles><title>Efficacy and safety of EUS-guided liver biopsy: a systematic review and meta-analysis</title><secondary-title>Gastrointest Endosc</secondary-title></titles><periodical><full-title>Gastrointest Endosc</full-title></periodical><pages>238-246.e3</pages><volume>89</volume><number>2</number><edition>2018/11/06</edition><keywords><keyword>Biopsy, Large-Core Needle/adverse effects/*methods</keyword><keyword>Endoscopic Ultrasound-Guided Fine Needle Aspiration/adverse effects/*methods</keyword><keyword>Endosonography/adverse effects/methods</keyword><keyword>Humans</keyword><keyword>Image-Guided Biopsy/adverse effects/methods</keyword><keyword>Liver/*pathology</keyword></keywords><dates><year>2019</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0016-5107</isbn><accession-num>30389469</accession-num><urls></urls><electronic-resource-num>10.1016/j.gie.2018.10.018</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[50]. Additionally, Diehl et alPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5EaWVobDwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [53], Gleeson et al ADDIN EN.CITE <EndNote><Cite><Author>Gleeson</Author><Year>2009</Year><RecNum>151</RecNum><DisplayText><style face="superscript">[54]</style></DisplayText><record><rec-number>151</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1569172741">151</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gleeson, F. C.</author><author>Levy, M. J.</author></authors></contributors><titles><title>EUS Trucut biopsy liver parenchyma acquisition and yield are comparable to that of a transjugular liver biopsy</title><secondary-title>Gastrointest Endosc</secondary-title></titles><periodical><full-title>Gastrointest Endosc</full-title></periodical><pages>1046; author reply 1046-7</pages><volume>70</volume><number>5</number><edition>2009/11/03</edition><keywords><keyword>Biopsy/*methods</keyword><keyword>Endosonography/*methods</keyword><keyword>Humans</keyword><keyword>*Jugular Veins</keyword><keyword>Liver/diagnostic imaging/*pathology</keyword><keyword>Liver Diseases/diagnostic imaging/*pathology</keyword><keyword>Reproducibility of Results</keyword></keywords><dates><year>2009</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>1097-6779 (Electronic)
0016-5107 (Linking)</isbn><accession-num>19879410</accession-num><urls><related-urls><url>;[54] and Stavropoulos et al ADDIN EN.CITE <EndNote><Cite><Author>Stavropoulos</Author><Year>2012</Year><RecNum>13</RecNum><DisplayText><style face="superscript">[55]</style></DisplayText><record><rec-number>13</rec-number><foreign-keys><key app="EN" db-id="x290tas09drpx7exwabxr5f6rpf9epw9xfae" timestamp="1569172169">13</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Stavropoulos, S. N.</author><author>Im, G. Y.</author><author>Jlayer, Z.</author><author>Harris, M. D.</author><author>Pitea, T. C.</author><author>Turi, G. K.</author><author>Malet, P. F.</author><author>Friedel, D. M.</author><author>Grendell, J. H.</author></authors></contributors><auth-address>Department of Gastroenterology, Hepatology and Nutrition, Winthrop-University Hospital, Mineola, New York, USA.</auth-address><titles><title>High yield of same-session EUS-guided liver biopsy by 19-gauge FNA needle in patients undergoing EUS to exclude biliary obstruction</title><secondary-title>Gastrointest Endosc</secondary-title></titles><pages>310-8</pages><volume>75</volume><number>2</number><edition>2012/01/18</edition><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Biopsy, Fine-Needle/adverse effects/instrumentation/*methods</keyword><keyword>Cholestasis/complications/diagnostic imaging/*pathology</keyword><keyword>Endosonography</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Liver Diseases/diagnostic imaging/etiology/*pathology</keyword><keyword>Liver Function Tests</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Prospective Studies</keyword><keyword>*Ultrasonography, Interventional/adverse effects</keyword></keywords><dates><year>2012</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1097-6779 (Electronic)
0016-5107 (Linking)</isbn><accession-num>22248599</accession-num><urls><related-urls><url>;[55] have conducted similar studies (n = 200, 40, 9 and 22, respectively) regarding EUS-LB with a 0% rate of complications.Advantages of EUS-LB: There are several advantages to utilizing the EUS-LB technique over more conventional methods of acquiring tissue samples. Generally, the EUS-LB is less invasive compared to the surgical/transjugular routes, translating to lower patient and procedure related adverse events. The EUS-LB provides clinicians with a real-time, detailed view of the biopsy needle through the course of the liver and the trajectory can be changed if needed as part of the “fanning” technique to get a more representative samplePEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bc2dlIFRlY2hub2xvZ3k8L0F1dGhvcj48WWVhcj4yMDA3
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ADDIN EN.CITE.DATA [61]. The procedure is quick, adding only a few minutes to the overall procedure time as shown by Diehl et al ADDIN EN.CITE <EndNote><Cite><Author>Diehl</Author><Year>2019</Year><RecNum>10</RecNum><DisplayText><style face="superscript">[13]</style></DisplayText><record><rec-number>10</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561073315">10</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Diehl, D. L.</author></authors></contributors><auth-address>Department of Gastroenterology and Nutrition, Geisinger Medical Center, 100 North Academy Avenue, 21-11, Danville, PA 17822, USA. Electronic address: dldiehl@geisinger.edu.</auth-address><titles><title>Endoscopic Ultrasound-guided Liver Biopsy</title><secondary-title>Gastrointest Endosc Clin N Am</secondary-title></titles><periodical><full-title>Gastrointest Endosc Clin N Am</full-title></periodical><pages>173-186</pages><volume>29</volume><number>2</number><edition>2019/03/09</edition><keywords><keyword>Abnormal liver tests</keyword><keyword>Cirrhosis</keyword><keyword>Core biopsy</keyword><keyword>Fine-needle aspiration</keyword><keyword>Fine-needle biopsy</keyword><keyword>Hepatic fibrosis</keyword><keyword>Liver biopsy</keyword></keywords><dates><year>2019</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1558-1950 (Electronic)
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ADDIN EN.CITE.DATA [62,63]. Patients are normally observed in the recovery room for 30 min as for any other EUS biopsy unlike 4 h for PCLB, which allows for rapid patient turnover and increased efficiency ADDIN EN.CITE <EndNote><Cite><Author>Diehl</Author><Year>2019</Year><RecNum>15</RecNum><DisplayText><style face="superscript">[13]</style></DisplayText><record><rec-number>15</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561144670">15</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Diehl, D. L.</author></authors></contributors><auth-address>Department of Gastroenterology and Nutrition, Geisinger Medical Center, 100 North Academy Avenue, 21-11, Danville, PA 17822, USA. Electronic address: dldiehl@geisinger.edu.</auth-address><titles><title>Endoscopic Ultrasound-guided Liver Biopsy</title><secondary-title>Gastrointest Endosc Clin N Am</secondary-title></titles><periodical><full-title>Gastrointest Endosc Clin N Am</full-title></periodical><pages>173-186</pages><volume>29</volume><number>2</number><edition>2019/03/09</edition><keywords><keyword>Biopsy, Needle/instrumentation/*methods</keyword><keyword>*Endosonography</keyword><keyword>Humans</keyword><keyword>Liver/*pathology</keyword><keyword>Liver Diseases/*diagnosis</keyword><keyword>Postoperative Care</keyword><keyword>Tissue Fixation</keyword><keyword>*Ultrasonography, Interventional</keyword><keyword>Abnormal liver tests</keyword><keyword>Cirrhosis</keyword><keyword>Core biopsy</keyword><keyword>Fine-needle aspiration</keyword><keyword>Fine-needle biopsy</keyword><keyword>Hepatic fibrosis</keyword><keyword>Liver biopsy</keyword></keywords><dates><year>2019</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1052-5157</isbn><accession-num>30846147</accession-num><urls></urls><electronic-resource-num>10.1016/j.giec.2018.11.002</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[13]. EUS-LB would also be suitable for individuals who are obese and may not be appropriate for the PCLB approach as well as for those who refuse the latter. Lastly, for patients who are planning to undergo an endoscopic procedure for another medical indication (e.g. screening for Barrett’s, gastroesophageal reflux disease, varices or esophagogastroduodenoscopy done as part of evaluation of dyspepsia) a LB can be performed simultaneously if required under the same anesthesia, reducing time, cost and risk of multiple procedures just for tissue acquisition. Disadvantages of EUS-LB: While EUS-LB has favorable components compared to earlier techniques, there are some disadvantages associated with its use. First, EUS-LB is a relatively new technique. As such, many clinicians who have grown accustomed to obtaining liver samples via the PC or TJ route have less experience utilizing this method ADDIN EN.CITE <EndNote><Cite><Author>Mohan</Author><Year>2019</Year><RecNum>23</RecNum><DisplayText><style face="superscript">[50]</style></DisplayText><record><rec-number>23</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561144670">23</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mohan, B. P.</author><author>Shakhatreh, M.</author><author>Garg, R.</author><author>Ponnada, S.</author><author>Adler, D. G.</author></authors></contributors><auth-address>University of Alabama, DCH Medical Center, Tuscaloosa, Alabama, USA.
Rapides Regional Medical Center, Alexandria, Louisiana, USA.
Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Carilion Roanoke Memorial Hospital, Roanoke, Virginia, USA.
Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA.</auth-address><titles><title>Efficacy and safety of EUS-guided liver biopsy: a systematic review and meta-analysis</title><secondary-title>Gastrointest Endosc</secondary-title></titles><periodical><full-title>Gastrointest Endosc</full-title></periodical><pages>238-246.e3</pages><volume>89</volume><number>2</number><edition>2018/11/06</edition><keywords><keyword>Biopsy, Large-Core Needle/adverse effects/*methods</keyword><keyword>Endoscopic Ultrasound-Guided Fine Needle Aspiration/adverse effects/*methods</keyword><keyword>Endosonography/adverse effects/methods</keyword><keyword>Humans</keyword><keyword>Image-Guided Biopsy/adverse effects/methods</keyword><keyword>Liver/*pathology</keyword></keywords><dates><year>2019</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0016-5107</isbn><accession-num>30389469</accession-num><urls></urls><electronic-resource-num>10.1016/j.gie.2018.10.018</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[50]. Similarly, the process of learning to use traditional methods of LB is much simpler compared to the higher level of technical skills required to learn and utilize the EUS-LB ADDIN EN.CITE <EndNote><Cite><Author>Cazacu</Author><Year>2018</Year><RecNum>116</RecNum><DisplayText><style face="superscript">[64]</style></DisplayText><record><rec-number>116</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1564886938">116</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cazacu, I. M.</author><author>Luzuriaga Chavez, A. A.</author><author>Saftoiu, A.</author><author>Vilmann, P.</author><author>Bhutani, M. S.</author></authors></contributors><auth-address>Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania; Department of Gastroenterology, Hepatology, and Nutrition, University of Texas - MD Anderson Cancer Center, Houston, Texas, USA.
Department of Gastroenterology, Hepatology, and Nutrition, University of Texas - MD Anderson Cancer Center, Houston, Texas, USA.
Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania.
Gastrounit, Division of Surgery, Copenhagen University Hospital Herlev, Copenhagen, Denmark.</auth-address><titles><title>A quarter century of EUS-FNA: Progress, milestones, and future directions</title><secondary-title>Endosc Ultrasound</secondary-title></titles><periodical><full-title>Endosc Ultrasound</full-title></periodical><pages>141-160</pages><volume>7</volume><number>3</number><edition>2018/06/27</edition><keywords><keyword>Eus</keyword><keyword>Eus-fna</keyword><keyword>tissue acquisition</keyword></keywords><dates><year>2018</year><pub-dates><date>May-Jun</date></pub-dates></dates><isbn>2303-9027 (Print)
2226-7190 (Linking)</isbn><accession-num>29941723</accession-num><urls><related-urls><url>;[64]. The core biopsy, though it often meets the criteria proposed by international societies (as mentioned in Table 3), will be smaller, as the needle commonly used is a 19G fine needle biopsy (FNB) for EUS, compared to a 16G in the PCLB route. Additionally, undergoing endoscopy for the sole purpose of LB can be expensive, therefore limiting widespread utilization ADDIN EN.CITE <EndNote><Cite><Author>Parekh</Author><Year>2015</Year><RecNum>44</RecNum><DisplayText><style face="superscript">[19]</style></DisplayText><record><rec-number>44</rec-number><foreign-keys><key app="EN" db-id="zwxrffpdpx00a7e5ddvp2tpctadrwr5dsd0p" timestamp="1563133674">44</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Parekh, P. J.</author><author>Majithia, R.</author><author>Diehl, D. L.</author><author>Baron, T. H.</author></authors></contributors><auth-address>Department of Internal Medicine, Division of Gastroenterology and Hepatology, Tulane University, New Orleans, Louisiana, USA.
Division of Gastroenterology and Hepatology, University of North Carolina - Johnston Healthcare, Smithfield, USA.
Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA.
Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA.</auth-address><titles><title>Endoscopic ultrasound-guided liver biopsy</title><secondary-title>Endosc Ultrasound</secondary-title></titles><periodical><full-title>Endosc Ultrasound</full-title></periodical><pages>85-91</pages><volume>4</volume><number>2</number><edition>2015/05/29</edition><keywords><keyword>EUS-guided liver biopsy (EUS-LB)</keyword><keyword>Endoscopic ultrasound (EUS)</keyword><keyword>Tru-Cut biopsy</keyword><keyword>fine needle biopsy</keyword><keyword>liver biopsy</keyword><keyword>nonalcoholic fatty liver disease (NAFLD)</keyword><keyword>nonalcoholic steatohepatitis (NASH)</keyword></keywords><dates><year>2015</year><pub-dates><date>Apr-Jun</date></pub-dates></dates><isbn>2303-9027 (Print)
2226-7190 (Linking)</isbn><accession-num>26020041</accession-num><urls><related-urls><url>;[19]. COMPARISON OF THE ADEQUACY OF DIAGNOSTIC SAMPLES AMONG LB METHODSObtaining an adequate histological sample is a vital step in the process of establishing a diagnosis. Various authorities have attempted to create objective parameters to assess the adequacy of samples, with very little consensus (Table 3). Adequacy has largely been described by the length of total specimen (TSL) and/or number of complete portal triads (CPTs), which includes the portal vein, hepatic artery and bile duct ADDIN EN.CITE <EndNote><Cite><Author>Colloredo</Author><Year>2003</Year><RecNum>119</RecNum><DisplayText><style face="superscript">[65]</style></DisplayText><record><rec-number>119</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1564977795">119</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Colloredo, G.</author><author>Guido, M.</author><author>Sonzogni, A.</author><author>Leandro, G.</author></authors></contributors><auth-address>Liver Unit, Seriate Hospital, Bergamo, Italy. mguido@unipd.it</auth-address><titles><title>Impact of liver biopsy size on histological evaluation of chronic viral hepatitis: the smaller the sample, the milder the disease</title><secondary-title>J Hepatol</secondary-title></titles><periodical><full-title>J Hepatol</full-title></periodical><pages>239-44</pages><volume>39</volume><number>2</number><edition>2003/07/23</edition><keywords><keyword>Biopsy, Needle/methods/*standards</keyword><keyword>Hepatitis B, Chronic/*pathology</keyword><keyword>Hepatitis C, Chronic/*pathology</keyword><keyword>Humans</keyword><keyword>Liver/*pathology</keyword><keyword>Pathology, Clinical/methods/standards</keyword><keyword>Reproducibility of Results</keyword><keyword>Severity of Illness Index</keyword></keywords><dates><year>2003</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0168-8278 (Print)
0168-8278 (Linking)</isbn><accession-num>12873821</accession-num><urls><related-urls><url>;[65]. Occasionally, the length of the longest piece (LLP) of tissue is also included as a defining element. Nonetheless, few studies have directly compared the adequacy of histologic samples acquired through conventional and novel methods of LB. Pineda et alPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5QaW5lZGE8L0F1dGhvcj48WWVhcj4yMDE2PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA [66] conducted a retrospective study comparing the adequacy of LB tissue samples obtained through the PCLB, TJLB and EUS-LB methods. PCLB was obtained with spring-loaded 18G, 19G, or 20G needles. TJLB samples were obtained with 18G or 19G needles and EUS-LB samples were obtained with regular 19G FNA needles. The number of CPTs and TSL using the EUS-LB method was found to be equivalent to PCLB and TJLB when only the left lobe was sampled. However, the study found that CPTs and TSL were significantly higher through the use of EUS-LB when both lobes were biopsiedPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5QaW5lZGE8L0F1dGhvcj48WWVhcj4yMDE2PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA [67] found that EUS-FNB could deliver adequate tissue samples and serve as an effective rescue method of LB in patients in which the PCLB method failed to obtain adequate tissue or render a diagnosis. Shuja et al[68] also retrospectively (n = 152) compared the adequacy of biopsies using the EUS-LB, PCLB, and TJLB methods for staging NASH fibrosis and found that EUS-LB produced increased TSL compared to traditional methods, with fewer complications. Likewise, Rombaoa et al[69] conducted a 2018 retrospective study (n = 8) of patients who had undergone EUS-LB with a 19G Acquire needle for abnormal LFTs, hepatitis B staging and cirrhosis. In the same study, they compared procedural and specimen results of patients who had a biopsy with the PCLB and EUS-LB method and found that numbers of CPTs were similar for both, but length of procedure and recovery times were much lower for patients in the EUS-LB group ADDIN EN.CITE <EndNote><Cite><Author>Rombaoa</Author><Year>2018</Year><RecNum>155</RecNum><DisplayText><style face="superscript">[68]</style></DisplayText><record><rec-number>155</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1569997503">155</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rombaoa, Christopher, Chen, Ann M</author></authors></contributors><titles><title>The Safety and Feasibilty of Endoscopic Ultrasound-Guided Parenchymal Liver Biopsy At A Large Community Hospital</title><secondary-title>Gastrointestinal Endoscopy</secondary-title></titles><periodical><full-title>Gastrointestinal Endoscopy</full-title></periodical><pages>AB458</pages><volume>87</volume><number>6</number><num-vols>Supplement</num-vols><dates><year>2018</year></dates><urls></urls><electronic-resource-num>10.1016/j.gie.2018.04.2001</electronic-resource-num></record></Cite></EndNote>[69]. As it seems, EUS-LB is comparable to conventional methods, while improving safety profile and providing a more efficient method of obtaining liver tissue. Figure 2 demonstrate the histology of LB from the EUS approach.EUS-LB: Early Tru-Cut needleEarly studies evaluating the efficacy of EUS-LB describe initial experiences using the 19G Tru-cut needle, albeit with variable outcomes. In a 2002 study, Wiersema et al ADDIN EN.CITE <EndNote><Cite><Author>Wiersema</Author><Year>2002</Year><RecNum>152</RecNum><DisplayText><style face="superscript">[69]</style></DisplayText><record><rec-number>152</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1569982080">152</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wiersema, M. J.</author><author>Levy, M. J.</author><author>Harewood, G. C.</author><author>Vazquez-Sequeiros, E.</author><author>Jondal, M. L.</author><author>Wiersema, L. M.</author></authors></contributors><auth-address>Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.</auth-address><titles><title>Initial experience with EUS-guided trucut needle biopsies of perigastric organs</title><secondary-title>Gastrointest Endosc</secondary-title></titles><periodical><full-title>Gastrointest Endosc</full-title></periodical><pages>275-8</pages><volume>56</volume><number>2</number><edition>2002/07/30</edition><keywords><keyword>Animals</keyword><keyword>Biopsy, Needle/*methods</keyword><keyword>Endosonography</keyword><keyword>Histological Techniques</keyword><keyword>Kidney/pathology</keyword><keyword>Liver/pathology</keyword><keyword>Pancreas/pathology</keyword><keyword>Spleen/*pathology</keyword><keyword>Swine</keyword></keywords><dates><year>2002</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0016-5107 (Print)
0016-5107 (Linking)</isbn><accession-num>12145612</accession-num><urls><related-urls><url>(02)70193-4</electronic-resource-num></record></Cite></EndNote>[70] described EUS-LB using a 19G Tru-Cut needle in swine models that produced a median TSL of 4 mm with 100% procurement of core tissue samples. However, the authors in this study reported procedural difficulty due to the rigidity and inflexibility of the needle while going through the endoscope ADDIN EN.CITE <EndNote><Cite><Author>Wiersema</Author><Year>2002</Year><RecNum>152</RecNum><DisplayText><style face="superscript">[69]</style></DisplayText><record><rec-number>152</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1569982080">152</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wiersema, M. J.</author><author>Levy, M. J.</author><author>Harewood, G. C.</author><author>Vazquez-Sequeiros, E.</author><author>Jondal, M. L.</author><author>Wiersema, L. M.</author></authors></contributors><auth-address>Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.</auth-address><titles><title>Initial experience with EUS-guided trucut needle biopsies of perigastric organs</title><secondary-title>Gastrointest Endosc</secondary-title></titles><periodical><full-title>Gastrointest Endosc</full-title></periodical><pages>275-8</pages><volume>56</volume><number>2</number><edition>2002/07/30</edition><keywords><keyword>Animals</keyword><keyword>Biopsy, Needle/*methods</keyword><keyword>Endosonography</keyword><keyword>Histological Techniques</keyword><keyword>Kidney/pathology</keyword><keyword>Liver/pathology</keyword><keyword>Pancreas/pathology</keyword><keyword>Spleen/*pathology</keyword><keyword>Swine</keyword></keywords><dates><year>2002</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0016-5107 (Print)
0016-5107 (Linking)</isbn><accession-num>12145612</accession-num><urls><related-urls><url>(02)70193-4</electronic-resource-num></record></Cite></EndNote>[70]. Later, Gleeson et al[54] conducted a case series review of nine patients who had undergone EUS-LB with the 19G Tru-cut needle for a variety of indications (i.e., dilated CBD, abnormal liver tests with suspicious image findings and tumor staging). The mean TSL was 16.9 mm, median number of CPTs was seven, and adequate diagnostic material was acquired in 100% of cases ADDIN EN.CITE <EndNote><Cite><Author>Gleeson</Author><Year>2009</Year><RecNum>151</RecNum><DisplayText><style face="superscript">[54]</style></DisplayText><record><rec-number>151</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1569172741">151</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gleeson, F. C.</author><author>Levy, M. J.</author></authors></contributors><titles><title>EUS Trucut biopsy liver parenchyma acquisition and yield are comparable to that of a transjugular liver biopsy</title><secondary-title>Gastrointest Endosc</secondary-title></titles><periodical><full-title>Gastrointest Endosc</full-title></periodical><pages>1046; author reply 1046-7</pages><volume>70</volume><number>5</number><edition>2009/11/03</edition><keywords><keyword>Biopsy/*methods</keyword><keyword>Endosonography/*methods</keyword><keyword>Humans</keyword><keyword>*Jugular Veins</keyword><keyword>Liver/diagnostic imaging/*pathology</keyword><keyword>Liver Diseases/diagnostic imaging/*pathology</keyword><keyword>Reproducibility of Results</keyword></keywords><dates><year>2009</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>1097-6779 (Electronic)
0016-5107 (Linking)</isbn><accession-num>19879410</accession-num><urls><related-urls><url>;[54]. However, in a 2009 study by DeWitt et al[71], 21 patients were evaluated for benign liver disease with the same Tru-Cut biopsy needle. A histologic diagnosis was obtained in 90% of cases, but the size of the samples did not meet standard criteria for histologic assessment ADDIN EN.CITE <EndNote><Cite><Author>Dewitt</Author><Year>2009</Year><RecNum>54</RecNum><DisplayText><style face="superscript">[70]</style></DisplayText><record><rec-number>54</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561144670">54</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Dewitt, J.</author><author>McGreevy, K.</author><author>Cummings, O.</author><author>Sherman, S.</author><author>Leblanc, J. K.</author><author>McHenry, L.</author><author>Al-Haddad, M.</author><author>Chalasani, N.</author></authors></contributors><auth-address>Division of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA. jodewitt@iupui.edu</auth-address><titles><title>Initial experience with EUS-guided Tru-cut biopsy of benign liver disease</title><secondary-title>Gastrointest Endosc</secondary-title></titles><periodical><full-title>Gastrointest Endosc</full-title></periodical><pages>535-42</pages><volume>69</volume><number>3 Pt 1</number><edition>2009/02/24</edition><keywords><keyword>Biopsy, Needle/*methods</keyword><keyword>*Endosonography</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Liver Diseases/*diagnostic imaging/*pathology</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Prospective Studies</keyword></keywords><dates><year>2009</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>0016-5107</isbn><accession-num>19231495</accession-num><urls></urls><electronic-resource-num>10.1016/j.gie.2008.09.056</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[71]. The Tru-Cut needle, partially due to the inflexible design, was deemed difficult to use, limiting its widespread adoption. EUS-LB with FNAGiven the limited adoption of the early TruCut needle, the search for alternative EUS-LB needles led to the use of a 19G EUS–FNA needle, which has long served as the mainstay for obtaining hepatic tissue. Multiple studies have demonstrated the accuracy and practicality of EUS-FNA using the 19G needlePEVuZE5vdGU+PENpdGU+PEF1dGhvcj5EZXdpdHQ8L0F1dGhvcj48WWVhcj4yMDA5PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA [71-73]. In 2012, Stavropoulos et al ADDIN EN.CITE <EndNote><Cite><Author>Stavropoulos</Author><Year>2012</Year><RecNum>13</RecNum><DisplayText><style face="superscript">[55]</style></DisplayText><record><rec-number>13</rec-number><foreign-keys><key app="EN" db-id="sfzfszfd4zpe5geresrxazpsdwwvwxx9adr0" timestamp="1569982090">13</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Stavropoulos, S. N.</author><author>Im, G. Y.</author><author>Jlayer, Z.</author><author>Harris, M. D.</author><author>Pitea, T. C.</author><author>Turi, G. K.</author><author>Malet, P. F.</author><author>Friedel, D. M.</author><author>Grendell, J. H.</author></authors></contributors><auth-address>Department of Gastroenterology, Hepatology and Nutrition, Winthrop-University Hospital, Mineola, New York, USA.</auth-address><titles><title>High yield of same-session EUS-guided liver biopsy by 19-gauge FNA needle in patients undergoing EUS to exclude biliary obstruction</title><secondary-title>Gastrointest Endosc</secondary-title></titles><pages>310-8</pages><volume>75</volume><number>2</number><edition>2012/01/18</edition><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Biopsy, Fine-Needle/adverse effects/instrumentation/*methods</keyword><keyword>Cholestasis/complications/diagnostic imaging/*pathology</keyword><keyword>Endosonography</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Liver Diseases/diagnostic imaging/etiology/*pathology</keyword><keyword>Liver Function Tests</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Prospective Studies</keyword><keyword>*Ultrasonography, Interventional/adverse effects</keyword></keywords><dates><year>2012</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1097-6779 (Electronic)
0016-5107 (Linking)</isbn><accession-num>22248599</accession-num><urls><related-urls><url>;[55] conducted a prospective case series of EUS-LB with a regular non-Tru-cut 19-G FNA needle in 22 patients with abnormal LFTs of unclear etiology. With a median TSL of 36.9 mm, median of 9 CPTs and a diagnosis achieved in 91% of cases, the authors concluded that EUS-FNA with a 19G FNA needle was effective with good diagnostic yield ADDIN EN.CITE <EndNote><Cite><Author>Stavropoulos</Author><Year>2012</Year><RecNum>13</RecNum><DisplayText><style face="superscript">[55]</style></DisplayText><record><rec-number>13</rec-number><foreign-keys><key app="EN" db-id="sfzfszfd4zpe5geresrxazpsdwwvwxx9adr0" timestamp="1569982090">13</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Stavropoulos, S. N.</author><author>Im, G. Y.</author><author>Jlayer, Z.</author><author>Harris, M. D.</author><author>Pitea, T. C.</author><author>Turi, G. K.</author><author>Malet, P. F.</author><author>Friedel, D. M.</author><author>Grendell, J. H.</author></authors></contributors><auth-address>Department of Gastroenterology, Hepatology and Nutrition, Winthrop-University Hospital, Mineola, New York, USA.</auth-address><titles><title>High yield of same-session EUS-guided liver biopsy by 19-gauge FNA needle in patients undergoing EUS to exclude biliary obstruction</title><secondary-title>Gastrointest Endosc</secondary-title></titles><pages>310-8</pages><volume>75</volume><number>2</number><edition>2012/01/18</edition><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Biopsy, Fine-Needle/adverse effects/instrumentation/*methods</keyword><keyword>Cholestasis/complications/diagnostic imaging/*pathology</keyword><keyword>Endosonography</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Liver Diseases/diagnostic imaging/etiology/*pathology</keyword><keyword>Liver Function Tests</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Prospective Studies</keyword><keyword>*Ultrasonography, Interventional/adverse effects</keyword></keywords><dates><year>2012</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1097-6779 (Electronic)
0016-5107 (Linking)</isbn><accession-num>22248599</accession-num><urls><related-urls><url>;[55]. Later, in a 2014 study (n = 10) by Gor et al ADDIN EN.CITE <EndNote><Cite><Author>Gor</Author><Year>2014</Year><RecNum>51</RecNum><DisplayText><style face="superscript">[72]</style></DisplayText><record><rec-number>51</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561144670">51</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gor, N.</author><author>Salem, S. B.</author><author>Jakate, S.</author><author>Patel, R.</author><author>Shah, N.</author><author>Patil, A.</author></authors></contributors><auth-address>Section of Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA.
Division of Pathology, Rush University Medical Center, Chicago, Illinois, USA.</auth-address><titles><title>Histological adequacy of EUS-guided liver biopsy when using a 19-gauge non-Tru-Cut FNA needle</title><secondary-title>Gastrointest Endosc</secondary-title></titles><periodical><full-title>Gastrointest Endosc</full-title></periodical><pages>170-2</pages><volume>79</volume><number>1</number><edition>2013/08/07</edition><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Biopsy, Fine-Needle/*instrumentation</keyword><keyword>Endoscopic Ultrasound-Guided Fine Needle Aspiration/*instrumentation/*standards</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Liver/*pathology</keyword><keyword>Liver Diseases/*pathology</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>*Needles</keyword><keyword>Retrospective Studies</keyword><keyword>Young Adult</keyword><keyword>Cpt</keyword><keyword>Tjlb</keyword><keyword>complete portal tract</keyword><keyword>transjugular liver biopsy</keyword></keywords><dates><year>2014</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0016-5107</isbn><accession-num>23916397</accession-num><urls></urls><electronic-resource-num>10.1016/j.gie.2013.06.031</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[73], patients had an EUS-LB with a 19G FNA needle for abnormal LFTs. There was a yield of 100% diagnostic adequacy, a mean TSL of 14.4, and a mean CPT of 9.2 with no reported complications ADDIN EN.CITE <EndNote><Cite><Author>Gor</Author><Year>2014</Year><RecNum>51</RecNum><DisplayText><style face="superscript">[72]</style></DisplayText><record><rec-number>51</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561144670">51</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gor, N.</author><author>Salem, S. B.</author><author>Jakate, S.</author><author>Patel, R.</author><author>Shah, N.</author><author>Patil, A.</author></authors></contributors><auth-address>Section of Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA.
Division of Pathology, Rush University Medical Center, Chicago, Illinois, USA.</auth-address><titles><title>Histological adequacy of EUS-guided liver biopsy when using a 19-gauge non-Tru-Cut FNA needle</title><secondary-title>Gastrointest Endosc</secondary-title></titles><periodical><full-title>Gastrointest Endosc</full-title></periodical><pages>170-2</pages><volume>79</volume><number>1</number><edition>2013/08/07</edition><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Biopsy, Fine-Needle/*instrumentation</keyword><keyword>Endoscopic Ultrasound-Guided Fine Needle Aspiration/*instrumentation/*standards</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Liver/*pathology</keyword><keyword>Liver Diseases/*pathology</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>*Needles</keyword><keyword>Retrospective Studies</keyword><keyword>Young Adult</keyword><keyword>Cpt</keyword><keyword>Tjlb</keyword><keyword>complete portal tract</keyword><keyword>transjugular liver biopsy</keyword></keywords><dates><year>2014</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0016-5107</isbn><accession-num>23916397</accession-num><urls></urls><electronic-resource-num>10.1016/j.gie.2013.06.031</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[73]. In 2015, Diehl et alPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5EaWVobDwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [51]. Though widely implemented, EUS-FNA may be limited in its ability to provide core tissue samples with good architecture. Further, the diagnostic yield of FNA is variable, depending on needle the size and type, operator experience as well as the obtainability of rapid onsite evaluation (ROSE).EUS-LB with FNBThe increasing utility of EUS-FNB, partly due to the advent of newly designed, more flexible, biopsy needles (EchoTip, ProCore, SharkCore, Acquire needle, EZ shot 3 plus needle, etc.) may improve diagnostic yield of LBs, and reduce or possibly negate the need for ROSE ADDIN EN.CITE <EndNote><Cite><Author>Ichim</Author><Year>2019</Year><RecNum>14</RecNum><DisplayText><style face="superscript">[73]</style></DisplayText><record><rec-number>14</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561144670">14</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ichim, V. A.</author><author>Chira, R. I.</author><author>Mircea, P. A.</author></authors></contributors><auth-address>Department of Internal Medicine. Division of Gastroenterology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.</auth-address><titles><title>Diagnostic yield of endoscopic ultrasound-guided biopsy of focal liver lesions</title><secondary-title>Med Pharm Rep</secondary-title></titles><periodical><full-title>Med Pharm Rep</full-title></periodical><pages>15-20</pages><volume>92</volume><number>1</number><edition>2019/04/09</edition><keywords><keyword>Eus-fna</keyword><keyword>focal liver lesions</keyword><keyword>liver biopsy</keyword></keywords><dates><year>2019</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>2602-0807</isbn><accession-num>30957081</accession-num><urls></urls><custom2>PMC6448489</custom2><electronic-resource-num>10.15386/cjmed-1066</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[74].In a 2016 cross-sectional study (n = 75) Sey et alPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TZXk8L0F1dGhvcj48WWVhcj4yMDE2PC9ZZWFyPjxSZWNO
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ADDIN EN.CITE.DATA [72] compared the diagnostic yield of a novel reverse bevel 19G FNB ProCore needle with the early 19G Tru-cut biopsy needle. The authors found that EUS-LB with the newer ProCore needle produced specimens with a longer median length (20 mm vs 9 mm), more CPTs and more adequate specimens with fewer passes. Shah et al ADDIN EN.CITE <EndNote><Cite><Author>Shah</Author><Year>2017</Year><RecNum>34</RecNum><DisplayText><style face="superscript">[74]</style></DisplayText><record><rec-number>34</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561144670">34</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shah, N. D.</author><author>Sasatomi, E.</author><author>Baron, T. H.</author></authors></contributors><auth-address>Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: todd_baron@med.unc.edu.</auth-address><titles><title>Endoscopic Ultrasound-guided Parenchymal Liver Biopsy: Single Center Experience of a New Dedicated Core Needle</title><secondary-title>Clin Gastroenterol Hepatol</secondary-title></titles><periodical><full-title>Clin Gastroenterol Hepatol</full-title></periodical><pages>784-786</pages><volume>15</volume><number>5</number><edition>2017/01/28</edition><keywords><keyword>Biopsy/*instrumentation/*methods</keyword><keyword>Endosonography/*instrumentation/*methods</keyword><keyword>Humans</keyword><keyword>Liver Diseases/*diagnosis</keyword><keyword>*Needles</keyword></keywords><dates><year>2017</year><pub-dates><date>May</date></pub-dates></dates><isbn>1542-3565</isbn><accession-num>28126424</accession-num><urls></urls><electronic-resource-num>10.1016/j.cgh.2017.01.011</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[75] reached a similar conclusion in a retrospective study (n = 24) of patients with abnormal LFTs and pancreatobiliary conditions, who had undergone EUS-LB with a novel 19G FNB SharkCore. A histologic diagnosis was achieved in 96% of cases, with a median TSL of 65.6, median CPT of 32.5 and a median of two passes. Nieto et alPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5OaWV0bzwvQXV0aG9yPjxZZWFyPjIwMTg8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [76] conducted a recent 2018 retrospective study (n = 165) using a modified 1-pass wet suction technique in patients with elevated LFTs of unclear etiology who had undergone EUS-LB for exclusion of biliary obstruction. The median TSL in their study was 6 cm, the median number of CPTs was 18 and the authors concluded that EUS-LB with the modified 1-pass wet suction technique was safe and effective.Recent studies have also demonstrated potential use with a smaller, 22G FNB needle. In a 2019 study (n = 40), Hasan et al ADDIN EN.CITE <EndNote><Cite><Author>Hasan</Author><Year>2019</Year><RecNum>153</RecNum><DisplayText><style face="superscript">[76]</style></DisplayText><record><rec-number>153</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1569982876">153</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hasan, M. K.</author><author>Kadkhodayan, K.</author><author>Idrisov, E.</author><author>Ali, S.</author><author>Rafiq, E.</author><author>Ben-Ami Shor, D.</author><author>Abdel-Jalil, A.</author><author>Navaneethan, U.</author><author>Bang, J.</author><author>Varadarajulu, S.</author><author>Hawes, R.</author><author>Pernicone, P.</author></authors></contributors><auth-address>Center for Interventional Endoscopy, AdventHealth Orlando, Florida, USA.
Department of Internal Medicine, AdventHealth Orlando, Florida, USA.
Department of Gastroenterology and Hepatology, AdventHealth Orlando, Florida, USA.
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Department of Pathology, AdventHealth Orlando, Florida, USA.</auth-address><titles><title>Endoscopic ultrasound-guided liver biopsy using a 22-G fine needle biopsy needle: a prospective study</title><secondary-title>Endoscopy</secondary-title></titles><periodical><full-title>Endoscopy</full-title></periodical><pages>818-824</pages><volume>51</volume><number>9</number><edition>2019/08/01</edition><dates><year>2019</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>1438-8812 (Electronic)
0013-726X (Linking)</isbn><accession-num>31365947</accession-num><urls><related-urls><url>;[77] analyzed biopsy results of patients referred for evaluation of elevated LFTs. There were two passes made from each hepatic lobe, yielding a median TSL of 55 mm, a median CPT of 42, and 100% specimen adequacy. Self-limiting abdominal pain was the only complication reported. In another recent 2019 prospective study (n = 41), Bazerbachi et alPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CYXplcmJhY2hpPC9BdXRob3I+PFllYXI+MjAxOTwvWWVh
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ADDIN EN.CITE.DATA [78] demonstrated that EUS-LB with a 22G fork-tip core biopsy needle can be accurately used to stage non-alcoholic fatty liver disease (NAFLD) and may be superior to magnetic resonance elastography (MRE) in detecting early fibrosis is NASH. The median TSL was 2.4 cm, median CPT was 26 and 100% of samples achieved adequacy in staging fibrosis. Comparison of diagnostic samples by needle: EUS-FNA vs EUS-FNBDifferent authors have conducted comparative evaluations of EUS-LB with FNA and FNB in attempt to establish a pattern of superiority. In a large 2017 study, Schulman et alPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TY2h1bG1hbjwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+
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ADDIN EN.CITE.DATA [79] directly compared the histologic samples of six different LB needles (19G Expect FNA needle, 19G SharkCore FNB needle, 22G SharkCore FNB needle, 19G Procore FNB needle and two 18-G PC needles) that were used on human cadavers. The mean number of CPTs (6.2) was significantly higher in specimens taken with the novel 19G SharkCore FNB needle. Similarly, both the 22G and 19G SharkCore FNB needle achieved the highest specimen adequacy and percent of core samples, suggesting superiority to the PC and 19G FNA needle in EUS-LB. Another recent study (n = 20) by Mok et al ADDIN EN.CITE <EndNote><Cite><Author>Mok</Author><Year>2019</Year><RecNum>20</RecNum><DisplayText><style face="superscript">[79]</style></DisplayText><record><rec-number>20</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561144670">20</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mok, S. R. S.</author><author>Diehl, D. L.</author><author>Johal, A. S.</author><author>Khara, H. S.</author><author>Confer, B. D.</author><author>Mudireddy, P. R.</author><author>Kovach, A. H.</author><author>Diehl, M. M.</author><author>Kirchner, H. L.</author><author>Chen, Z. E.</author></authors></contributors><auth-address>Geisinger Medical Center, Department of Gastroenterology and Hepatology, Division of Interventional Endoscopy, Danville, Pennsylvania, United States.</auth-address><titles><title>Endoscopic ultrasound-guided biopsy in chronic liver disease: a randomized comparison of 19-G FNA and 22-G FNB needles</title><secondary-title>Endosc Int Open</secondary-title></titles><periodical><full-title>Endosc Int Open</full-title></periodical><pages>E62-e71</pages><volume>7</volume><number>1</number><edition>2019/01/17</edition><dates><year>2019</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>2364-3722 (Print)
2196-9736</isbn><accession-num>30648141</accession-num><urls></urls><custom2>PMC6327728</custom2><electronic-resource-num>10.1055/a-0655-7462</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[80] evaluated tissue adequacy of a 22G FNB needle and a 19G FNA needle and found that the 19G FNA needle had greater tissue adequacy. However, a major limitation of this study is that the authors compared two different types of needles and two different gauges, making it difficult to conclude that the findings observed in this study were due differences in gauges and not the result of both variables compounded.A meta-analysis by Khan et al ADDIN EN.CITE <EndNote><Cite><Author>Khan</Author><Year>2017</Year><RecNum>96</RecNum><DisplayText><style face="superscript">[80]</style></DisplayText><record><rec-number>96</rec-number><foreign-keys><key app="EN" db-id="zwxrffpdpx00a7e5ddvp2tpctadrwr5dsd0p" timestamp="1566832325">96</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Khan, M. A.</author><author>Grimm, I. S.</author><author>Ali, B.</author><author>Nollan, R.</author><author>Tombazzi, C.</author><author>Ismail, M. K.</author><author>Baron, T. H.</author></authors></contributors><auth-address>Division of Gastroenterology and Hepatology, University of Tennessee Health Science Center, Memphis, TN, USA.
Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA.
University of Tennessee Health Science Center Library, Memphis, TN, USA.</auth-address><titles><title>A meta-analysis of endoscopic ultrasound-fine-needle aspiration compared to endoscopic ultrasound-fine-needle biopsy: diagnostic yield and the value of onsite cytopathological assessment</title><secondary-title>Endosc Int Open</secondary-title></titles><periodical><full-title>Endosc Int Open</full-title></periodical><pages>E363-E375</pages><volume>5</volume><number>5</number><edition>2017/05/13</edition><dates><year>2017</year><pub-dates><date>May</date></pub-dates></dates><isbn>2364-3722 (Print)
2196-9736 (Linking)</isbn><accession-num>28497108</accession-num><urls><related-urls><url>;[81] found similar diagnostic yield between EUS-FNA and EUS-FNB, but only when ROSE was used with FNA. Without ROSE, FNB produced better diagnostic adequacy in solid lesions and required fewer passes to reach a diagnosis. Similarly, another meta-analysis of studies comparing sample quality between the FNB ProCore needle and the standard FNA needle also showed comparable sampling and diagnostic results. However, the ProCore needle was able to obtain a diagnosis with fewer passes ADDIN EN.CITE <EndNote><Cite><Author>Bang</Author><Year>2016</Year><RecNum>94</RecNum><DisplayText><style face="superscript">[81]</style></DisplayText><record><rec-number>94</rec-number><foreign-keys><key app="EN" db-id="zwxrffpdpx00a7e5ddvp2tpctadrwr5dsd0p" timestamp="1566828889">94</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bang, J. Y.</author><author>Hawes, R.</author><author>Varadarajulu, S.</author></authors></contributors><auth-address>Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, United States.
Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, United States.</auth-address><titles><title>A meta-analysis comparing ProCore and standard fine-needle aspiration needles for endoscopic ultrasound-guided tissue acquisition</title><secondary-title>Endoscopy</secondary-title></titles><periodical><full-title>Endoscopy</full-title><abbr-1>Endoscopy</abbr-1></periodical><pages>339-49</pages><volume>48</volume><number>4</number><edition>2015/11/13</edition><keywords><keyword>Endoscopic Ultrasound-Guided Fine Needle Aspiration/*instrumentation</keyword><keyword>Endosonography/*methods</keyword><keyword>Equipment Design</keyword><keyword>Humans</keyword><keyword>Pancreas/*diagnostic imaging</keyword><keyword>Pancreatic Neoplasms/*diagnosis</keyword><keyword>Reproducibility of Results</keyword></keywords><dates><year>2016</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1438-8812 (Electronic)
0013-726X (Linking)</isbn><accession-num>26561917</accession-num><urls><related-urls><url>;[82]. To further compare, a prospective trial (n = 40) of EUS-LBs demonstrated that 19?G FNB needles produced specimens with longer specimen length, longer pieces of tissue core and more CPTs compared to 19G FNA needles ADDIN EN.CITE <EndNote><Cite><Author>Ching-Companioni</Author><Year>2019</Year><RecNum>93</RecNum><DisplayText><style face="superscript">[82]</style></DisplayText><record><rec-number>93</rec-number><foreign-keys><key app="EN" db-id="zwxrffpdpx00a7e5ddvp2tpctadrwr5dsd0p" timestamp="1566828343">93</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ching-Companioni, R. A.</author><author>Diehl, D. L.</author><author>Johal, A. S.</author><author>Confer, B. D.</author><author>Khara, H. S.</author></authors></contributors><auth-address>Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, United States.</auth-address><titles><title>19 G aspiration needle versus 19 G core biopsy needle for endoscopic ultrasound-guided liver biopsy: a prospective randomized trial</title><secondary-title>Endoscopy</secondary-title></titles><periodical><full-title>Endoscopy</full-title><abbr-1>Endoscopy</abbr-1></periodical><edition>2019/07/26</edition><dates><year>2019</year><pub-dates><date>Jul 23</date></pub-dates></dates><isbn>1438-8812 (Electronic)
0013-726X (Linking)</isbn><accession-num>31342474</accession-num><urls><related-urls><url>;[83].Tissue acquisition techniquesDifferent techniques of tissue acquisition have been proposed to improve the diagnostic yield of EUS-LB. Many endoscopists use suction techniques or a slow-pull technique with FNA[7]. Some of the common EUS-LB suction techniques include dry heparin, dry suction technique (DRST) and wet suction technique (WEST). High negative pressure suction with an air-filled pre-vacuum syringe has been used in conventional EUS-FNA, but diminishes the sample quality by increasing the amount of blood in the specimen ADDIN EN.CITE <EndNote><Cite><Author>Wallace</Author><Year>2001</Year><RecNum>102</RecNum><DisplayText><style face="superscript">[83]</style></DisplayText><record><rec-number>102</rec-number><foreign-keys><key app="EN" db-id="zwxrffpdpx00a7e5ddvp2tpctadrwr5dsd0p" timestamp="1566863372">102</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wallace, M. B.</author><author>Kennedy, T.</author><author>Durkalski, V.</author><author>Eloubeidi, M. A.</author><author>Etamad, R.</author><author>Matsuda, K.</author><author>Lewin, D.</author><author>Van Velse, A.</author><author>Hennesey, W.</author><author>Hawes, R. H.</author><author>Hoffman, B. J.</author></authors></contributors><auth-address>Division of Gastroenterology and Hepatology, Digestive Disease Center, Medical University of South Carolina, 96 Jonathan Lucas St., Charleston, SC 29425, USA.</auth-address><titles><title>Randomized controlled trial of EUS-guided fine needle aspiration techniques for the detection of malignant lymphadenopathy</title><secondary-title>Gastrointest Endosc</secondary-title></titles><periodical><full-title>Gastrointest Endosc</full-title><abbr-1>Gastrointestinal endoscopy</abbr-1></periodical><pages>441-7</pages><volume>54</volume><number>4</number><edition>2001/09/29</edition><keywords><keyword>Biopsy, Needle/*methods</keyword><keyword>*Endosonography</keyword><keyword>Humans</keyword><keyword>Lymph Nodes/*pathology</keyword><keyword>Lymphatic Diseases/*diagnosis</keyword><keyword>Lymphatic Metastasis/*pathology</keyword><keyword>Prospective Studies</keyword><keyword>Specimen Handling</keyword><keyword>Suction</keyword></keywords><dates><year>2001</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>0016-5107 (Print)
0016-5107 (Linking)</isbn><accession-num>11577304</accession-num><urls><related-urls><url>;[84]. The WEST, on the other hand, was designed to address this specific issue and improve tissue yield. The WEST essentially uses pre-flushed saline instead of air. A prospective study found significantly greater cellularity and improved diagnostic yield in the WEST compared to DRSTPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BdHRhbTwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [53]. Other techniques used include the fanning technique, which is used to obtain more tissue with fewer passes and the slow pull technique, which relies upon the negative pressure within the needle as the stylet is being slowly removed by the assistant during FNA “throws”PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LaW48L0F1dGhvcj48WWVhcj4yMDE1PC9ZZWFyPjxSZWNO
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ADDIN EN.CITE.DATA [86].While these techniques are useful for EUS-FNA, few studies have explored techniques that can be applied when using newer FNB needles. The modified 1-pass 1 actuation wet suction technique, however, may show promise. One recent retrospective study (n = 165) described the modified 1-pass 1 actuation wet suction technique with a 19G EUS-FNB (SharkCore) needle in patients evaluated for abnormal liver chemistries. The median TSL was 6 cm and the mean of CPTs was 7.5 cm, suggesting an effective techniquePEVuZE5vdGU+PENpdGU+PEF1dGhvcj5OaWV0bzwvQXV0aG9yPjxZZWFyPjIwMTg8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [87] also concluded that the 19G core biopsy needle with the use of the modified one-pass wet suction technique was more accurate in diagnosing and staging NAFLD compared to MRE. EUS-LB in special populationsGastric bypass: Patients with altered anatomy, such as a gastric bypass, may also undergo EUS-LB safely and effectively. Amongst the cohort of patients evaluated for abnormal liver enzymes or liver disease in a prospective study by Diehl et alPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5EaWVobDwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+PFJl
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ADDIN EN.CITE.DATA [51]. Liver transplant patients: Patients with a history of liver transplantation comprise a unique group in which LB may be required. Indications for LB in this population include histologic evaluation (in pre-transplant liver donors), monitoring for evidence of graft injury, confirming a diagnosis in patients with acutely abnormal LFTs, assessing the degree of injury or fibrosis, and monitoring changes following therapeutic intervention ADDIN EN.CITE <EndNote><Cite><Author>Adeyi</Author><Year>2010</Year><RecNum>69</RecNum><DisplayText><style face="superscript">[87]</style></DisplayText><record><rec-number>69</rec-number><foreign-keys><key app="EN" db-id="zwxrffpdpx00a7e5ddvp2tpctadrwr5dsd0p" timestamp="1566501064">69</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Adeyi, O.</author><author>Fischer, S. E.</author><author>Guindi, M.</author></authors></contributors><auth-address>University Health Network/University of Toronto, Ontario, Canada.</auth-address><titles><title>Liver allograft pathology: approach to interpretation of needle biopsies with clinicopathological correlation</title><secondary-title>J Clin Pathol</secondary-title></titles><periodical><full-title>J Clin Pathol</full-title></periodical><pages>47-74</pages><volume>63</volume><number>1</number><edition>2009/10/23</edition><keywords><keyword>Biopsy, Needle/methods</keyword><keyword>Chronic Disease</keyword><keyword>Diagnosis, Differential</keyword><keyword>Graft Rejection/immunology/pathology</keyword><keyword>Humans</keyword><keyword>Liver/*pathology</keyword><keyword>Liver Diseases/pathology</keyword><keyword>Liver Transplantation/*pathology</keyword><keyword>Postoperative Complications/pathology</keyword><keyword>Recurrence</keyword></keywords><dates><year>2010</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>1472-4146 (Electronic)
0021-9746 (Linking)</isbn><accession-num>19847014</accession-num><urls><related-urls><url>;[88]. A retrospective study, in which nearly a quarter of participants were liver transplant patients, found that EUS-LB was safe and effective in evaluating post liver transplant patients with abnormal liver chemistries. EUS-LB was performed successfully with a 19G core needle via modified wet suction technique, with no complications or adverse events noted in the transplant group ADDIN EN.CITE <EndNote><Cite><Author>Ahmed A. Alsaiari</Author><Year>2018</Year><RecNum>149</RecNum><DisplayText><style face="superscript">[88]</style></DisplayText><record><rec-number>149</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1568860457">149</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ahmed A. Alsaiari, Muhammad F. Mubarak, George Therapondos, Richardo Romero, John Evans, Janak N. Shah, Ari Cohen, Gretchen Galliano, Abdul H. El Chafic</author></authors></contributors><titles><title>Endoscopic Ultrasound-Guided Liver Biopsy: A Tertiary Center Experience</title><secondary-title>Gastrointestinal Endoscopy</secondary-title></titles><periodical><full-title>Gastrointestinal Endoscopy</full-title></periodical><pages>Pages AB339–AB340 </pages><volume>87</volume><number>6</number><num-vols>Supplement</num-vols><dates><year>2018</year></dates><urls></urls><electronic-resource-num>10.1016/j.gie.2018.04.1726</electronic-resource-num></record></Cite></EndNote>[89]. Multiple larger studies are needed to clearly identify the role of EUS-LB in post-transplant patients as they pose unique challenges in terms of post-surgery status, anatomical variations and higher risk of post procedure infections.Pediatric patients: Much of the existing literature regarding the efficacy of EUS-LB is limited to studies pertaining to the adult population, but very few studies have evaluated the use of EUS-LB in the pediatric population. Johal et al ADDIN EN.CITE <EndNote><Cite><Author>Johal</Author><Year>2014</Year><RecNum>48</RecNum><DisplayText><style face="superscript">[89]</style></DisplayText><record><rec-number>48</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561144670">48</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Johal, A. S.</author><author>Khara, H. S.</author><author>Maksimak, M. G.</author><author>Diehl, D. L.</author></authors></contributors><auth-address>Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA.
Department of Pediatric Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA.</auth-address><titles><title>Endoscopic ultrasound-guided liver biopsy in pediatric patients</title><secondary-title>Endosc Ultrasound</secondary-title></titles><periodical><full-title>Endosc Ultrasound</full-title></periodical><pages>191-4</pages><volume>3</volume><number>3</number><edition>2014/09/04</edition><keywords><keyword>Abnormal liver enzymes</keyword><keyword>endoscopic ultrasound</keyword><keyword>liver biopsy</keyword><keyword>liver disease</keyword><keyword>pediatric patients</keyword></keywords><dates><year>2014</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>2303-9027 (Print)
2226-7190</isbn><accession-num>25184126</accession-num><urls></urls><custom2>PMC4145480</custom2><electronic-resource-num>10.4103/2303-9027.138794</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[90] reported the first known case series (n = 3) demonstrating the usefulness and safety of EUS-LB in three pediatric subjects who were evaluated for persistently elevated liver enzymes of unclear etiology. The biopsy was successfully performed with a 19G EUS-FNA needle and allowed for good histological return in all three cases yielding CPTs of 20, 31 and 16, and a tissue lengths of 30 mm, 53 mm and 62 mm. No procedure related adverse events or complications were noted in any of the children. Additional studies in this particular population are needed, but preliminary reports suggest that EUS-LB in pediatric patients is safe and effective ADDIN EN.CITE <EndNote><Cite><Author>Johal</Author><Year>2014</Year><RecNum>48</RecNum><DisplayText><style face="superscript">[89]</style></DisplayText><record><rec-number>48</rec-number><foreign-keys><key app="EN" db-id="0p5ppp0td2xawrewd0appxddzt0ddzrfz525" timestamp="1561144670">48</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Johal, A. S.</author><author>Khara, H. S.</author><author>Maksimak, M. G.</author><author>Diehl, D. L.</author></authors></contributors><auth-address>Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA.
Department of Pediatric Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA.</auth-address><titles><title>Endoscopic ultrasound-guided liver biopsy in pediatric patients</title><secondary-title>Endosc Ultrasound</secondary-title></titles><periodical><full-title>Endosc Ultrasound</full-title></periodical><pages>191-4</pages><volume>3</volume><number>3</number><edition>2014/09/04</edition><keywords><keyword>Abnormal liver enzymes</keyword><keyword>endoscopic ultrasound</keyword><keyword>liver biopsy</keyword><keyword>liver disease</keyword><keyword>pediatric patients</keyword></keywords><dates><year>2014</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>2303-9027 (Print)
2226-7190</isbn><accession-num>25184126</accession-num><urls></urls><custom2>PMC4145480</custom2><electronic-resource-num>10.4103/2303-9027.138794</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[90].CONCLUSIONLB is an essential tool in diagnosing, evaluating and treating various diseases of the liver. While the traditional PCLB and TJLB methods are established and have been used extensively, there are some disadvantages to their use. Thus, EUS-LB represents a more novel, effective and safe alternative to obtaining hepatic tissue with several advantages. EUS-LB allows for detection of smaller lesions and bi-lobar liver sampling, which in turn improves tissue yield and obtains more representative sampling, allowing for greater diagnostic potential. The use of real time imaging guidance with doppler also helps reduce inadvertent injury to pertinent anatomic structures and procedure related complications. 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Gastrointest Endosc 2018; 87: AB339-AB40 [DOI: 10.1016/j.gie.2018.04.1726]90 Johal AS, Khara HS, Maksimak MG, Diehl DL. Endoscopic ultrasound-guided liver biopsy in pediatric patients. Endosc Ultrasound 2014; 3: 191-194 [PMID: 25184126 DOI: 10.4103/2303-9027.138794]Footnotes Conflict-of-interest statement: Yee EU is a consultant for PathAI. No financial support.Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: : Invited?manuscriptPeer-review started: October 25, 2019 First decision: November 5, 2019Article in press:Specialty?type: Gastroenterology and hepatologyCountry?of?origin: United StatesPeer-review?report?classificationGrade?A?(Excellent): 0Grade?B?(Very?good): B, BGrade?C?(Good): 0Grade?D?(Fair): 0Grade?E?(Poor): 0P- Reviewer: Javaherizadeh H, Vynios D S- Editor: Wang JL L- Editor: E- Editor:Figure Legends Figure 1 The endoscopic ultrasound guided liver biopsy provides clinicians with a real-time, detailed view of the biopsy needle through the course of the liver.Figure 2 Histology of liver biopsy from the endoscopic ultrasound approach. A: Liver parenchyma with macrovesicular steatosis and focal ballooning degeneration (200× magnification, hematoxylin-eosin staining); B: Liver parenchyma with portal tract (center, 200× magnification, hematoxylin-eosin staining); C: Liver biopsy performed to target a mass lesion that was a clinically suspected metastasis (40× magnification, hematoxylin-eosin staining). The majority of the biopsy is composed of pleomorphic epithelioid cells in sheets and trabeculae that was suggestive of metastatic germ cell tumor.?Table 1 Advantages and disadvantages of liver biopsy methodsPercutaneous liver biopsyTransjugular liver bipsySurgeryEndoscopic ultrasound guided liver biopsyIndicationMainstay method of liver biopsy for unexplained abnormal LFTs, assessing, staging, diagnosing liver diseaseCoagulopathy; ascites; morbid obesity; failure of percutaneous liver biopsy ; thrombocytopeniaUndergoing surgery for another indicationUndergoing endoscopy for another indicationComplicationsPain; hemorrhage;peritonitis; hypotension; infection; gallbladder perforation; pneumothorax; hemothoraxHemorrhage; paincapsule perforation; arterial aneurysms; arrhythmiasHemorrhage, abdominal wall injury; intraperitoneal injury; anesthesia related complicationsHemorrhage; abdominal pain; infectionAdvantageWell-known procedure; cost effective; less technical skills requiredDecreased risk of complications; more tolerable; useful in patients with comorbiditiesCan take LB while performing another procedureIncreased tolerability; decreased recovery time; decreased complications; bi-lobar access; decreased sampling variability; View anatomical/vascular structuresDisadvantageIncreased sampling variability; less tolerable; require more passes; increased risk of complicationsLimited view of liver parenchyma and vascular anatomy; increased sample fragmentationInvasive; requires surgical specialtyCostly, if not performed along with another endoscopic procedureTable 2 Comprehensive review of studies on endoscopic ultrasound guided liver biopsyRef.Study designnIndicationNeedle used No of passesCPTsTSLInsufficient sampleAdverse eventsWiersema et al[70], 2002Prospective cohort 9No medical indication19G Tru-cutNR14 mm 0NoneGleeson et al[54], 2008Retrospective case series9Hepatic parenchymal disease19G Tru-cut2 7 16.9 mm 0NoneDeWitt et al[71], 2009Prospective case series21Hepatic parenchymal disease19G Tru-cut32 9 mm 10%NoneStavropoulos et al[55], 2012Prospective case series22Abnormal LFTs19G FNA (non-Tru-cut)29 36.9 mm 9%NoneGor et al[73], 2014Prospective case series10Abnormal LFTs; Suspected cirrhosis 19G FNA (non-Tru-cut)39.214.4 mm 0NoneDiehl et al[51], 2015Retrospective cohort110Persistent transaminitis19G FNA Expect Flexible1 to 214 38 mm 2%Self-limited bleedingLee et al[67], 2015Prospective cohort21Rescue for PCLB22G FNB 25G FNB2NRNR9.50%NonePineda et al[66], 2016Retrospective cohort 110Abnormal LFTs of Unknown Etiology19G FNA Expect/Flexible31438 mm2%NRSey et al[72], 2016Prospective Cross-sectional75Suspected parenchymal disease19G FNB ProCore; 19G FNB Tru-Cut2; 3 5; 220 mm; 9 mm 3%; 27%None; PainSchulman et al[79], 2017Prospective ex-vivo48No medical indication18G1 (percutaneous); 18G2 (percutaneous); 19G FNA Expect; 19G FNB ProCore; 19G FNB SharkCore; 22G FNB SharkCore1 to 22.5; 3.5; 1.9; 1.7; 6.2; 3.8NR; NR; NR; NR; NR; NR16.7%; 18.7%; 54%; 81%; 14.6%; 14.6%NoneMok et al[53], 2017Prospective cross-over20Elevated LFT Unknown Etiology19G FNB; 22G FNB SharkCoreNR7.4; 6.176.5 mm; 66.9 mm2.5%; 2.5%NonePainShah et al[75], 2017Retrospective chart review24Abnormal LFTs, pancreaticobiliary disease19G FNB SharkCore2 32.565.6 mm 4%Pain Subcapsular bleedingSaab et al[87], 2017Retrospective chart review47Biliary tract disease, abnormal LFTs19G FNB SharkCoreNR1865 mm 0Self-limited liver hematomasChing-Companioni et al[83], 2018Prospective randomized40Abnormal LFTs19G FNA Expect Flexible; 19G FNB Acquire1; 1 38; 16.5 11.8 mm; 16.3 mm0PainNieto et al[76], 2018Prospective observational165Unexplained abnormal LFTs, biliary obstruction19G FNB SharkCore118 60 mm 0Abdominal pain Self-limited hematomaMok et al[80], 2018Prospective cross-over40Parenchymal liver disease19G FNA Expect Flexible; 19G FNA Expect Flexible; 19G FNA Expect Flexible34; 4; 723.9 mm; 29.7 mm; 49.2 mm20%; 7%; 2%Postprocedural bleedingRombaoa et al[69], 2018Retrospective chart review8Unexplained abnormal LFTs, hepatitis B staging, cirrhosis 19G FNB Acquire29.4NRNRNoneShuja et al[68], 2019Retrospective Observational Cohort69NASH fibrosis staging19G FNA Expect Flexible310.84 45.8 mmNRNoneHasan et al[77], 2019Prospective nonrandomized trial40Elevated liver enzymes22G FNB Acquire2 L; 1 R42 55 mm0Self-limiting abdominal painBazerbachi et al[78], 2019Prospective cohort 41NAFLD diagnosis, staging22G FNB Fork-tip22624 mm 0Postprocedural painFNB: Fine needle biopsy; FNA; Fine needle aspiration; TSL; Total Specimen length; CPT: Complete portal tracts; n: Number of study participants; NAFLD: Non-alcoholic fatty liver disease; NASH: Nonalcoholic steatohepatitis.Table 3 Summary of society guidelines for adequate liver biopsyMedical societyTotal specimen length Complete portal triads Needle sizeAmerican Association for the Study of Liver Diseases 2-3 cm≥ 1116GEuropean Association for the Study of the Liver 15 mm--Asian Pacific Association for the Study of the Liver 15 mm≥ 1016G ................
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