Endoscopic Ultrasound-Guided, Percutaneous, and Transjugular Liver Biopsy: A Comparative Systematic Review and Meta-Analysis

Abstract

Background/Aims: Percutaneous liver biopsy (PCLB) or transjugular liver biopsy (TJLB) have traditionally been performed to obtain a sample of hepatic tissue; however, endoscopic ultrasound-guided liver biopsy (EUSLB) has become an attractive alternative. The aim of this study was to compare the efficacy and safety of EUSLB, PCLB, and TJLB. Methods: Search strategies were developed in accordance with PRISMA and MOOSE guidelines. Major outcomes included the following: adequacy of biopsy specimens (i.e., complete portal triads [CPT], total specimen length [TSL] in mm, and length of longest piece [LLP]) in mm), and rate of adverse events. Only studies comparing all biopsy approaches (i.e., EUSLB, PCLB, and TJLB) were included. Results: Five studies (EUSLB [n=301]; PCLB [n=176]; and TJLB [n=179]) were included. Biopsy cumulative adequacy rates for EUSLB, PCLB, and TJLB were 93.51%, 98.27%, and 97.61%, respectively. Based on the subgroup analysis limited to EUS biopsy needles in current clinical practice, there was no difference in biopsy adequacy or adverse events for EUSLB compared to PCLB and TJLB (all p>0.050). A comparison of EUSLB and PCLB revealed no difference between specimens regarding both CPT (p=0.079) and LLP (p=0.085); however, a longer TSL (p<0.001) was observed. Compared to TJLB, EUSLB showed no difference in LLP (p=0.351), fewer CPT (p=0.042), and longer TSL (p=0.005). Conclusions: EUSLB appears to be a safe, minimally invasive procedure that is comparable to PCLB and TJLB regarding biopsy specimens obtained and rate of adverse events associated with each method.

Feasibility and Safety of Transjugular Liver Biopsy for Japanese Patients with Chronic Liver Diseases

“…In general, EUS-guided fine-needle aspiration (EUS-FNA) for various diseases should be performed with caution in patients with abnormal coagulation [ 17 ], and the recommendation is to consider alternative biopsy methods if possible. With TJLB, safely collecting liver tissue is feasible even in the aforementioned high risk patients who are ineligible for PLB under ultrasound guidance or in patients in whom the procedure is difficult to perform, and patients benefit from the increase in techniques to choose from [ 18 , 19 , 20 , 21 , 22 ].…”

Outpatient Percutaneous Liver Biopsy is a Low-risk Procedure and has Steatosis as a New Indication Trend

“…According to the literature, the patient's position after the PLB does not affect the rate and severity of complications 20 , so our patients decided a comfortable position to rest. At our center, the protocol is to maintain observation for up to 4 to 6 hours after PLB, but the most appropriate period has not been well defined in the literature and it can last from 2 to 8 hours 4,9,[21][22][23] .…”

Role of Endoscopic Ultrasound in Liver Disease: Where Do We Stand?

“…Since the first published cases of EUS-LB in 2007 using a novel Tru-Cut core biopsy needle (QuickCore; Cook Medical, Winston Salem, NC, USA) [22][23][24], there have been numerous studies showing comparable adequacy and complication rates [3]. Yet, the EUS technique still affords many advantages over percutaneous and transjugular approaches.…”

“…Endoscopic ultrasound (EUS) is an unavoidable method for the evaluation of the pancreatobiliary and upper gastrointestinal tract with an expanding role in the field of hepatology. The limitations of conventional diagnostic tools and percutaneous interventions for liver disease, mostly done with transabdominal ultrasound (US) or computed tomography (CT) guidance, have made EUS an attractive alternative, predominantly due to the enhanced imaging quality and safety profile along with the biopsy acquisition ability regardless of body habitus [3,4].…”