 Alternative methods for acquisition of a core biopsy of the liver may be helpful in patients in whom percutaneous and transjugular liver biopsies would be difficult, risky or contraindicated. Endoscopic ultrasound EUS-guided fine needle aspiration EUS-FNA has been used for over 15 years at Indiana University Medical Center and other hospitals to sample lymph nodes and masses in the posterior mediastinum, upper abdomen and pelvis.24-29 In 2003, we published our experience of EUS-FNA of the liver using a 22-gauge needle in 77 patients without complications and to date this remains the largest series reported in the literature.30 Since that report, we have performed this procedure in over 100 patients also without a known complication not published. In 2003, the FDA approved development of a 19-gauge Trucut biopsy TCB device Wilson-Cook Medical, Inc.; Winston-Salem, North Carolina that provides a histologic tissue sample for use with EUS. The initial reported use of this device demonstrated its safety and utility for biopsy of major upper abdominal organs including the liver in a swine model.31 Its subsequent use for sampling of gastrointestinal stromal tumors GISTs, pancreatic masses and mediastinal lymph nodes in humans has also been reported.312-35 We have also studied its use in the diagnosis of nonfocal chronic pancreatitis.36 At Indiana University, we our EUS group have used this device in over 30 patients off protocol for various accepted indications without known complications not published. The use of this EUS-TCBdevice for liver biopsy has been reported in abstract form in only two patients with suspected metastatic malignancy.37 No complications were reported in these two patients. Its use for suspected benign disease of the liver has not been reported to date. 