Safety and adequacy of endoscopic ultrasound-guided random liver biopsy in comparison with transjugular and percutaneous approaches

Abstract

Background and study aims Endoscopic ultrasound-guided liver biopsy (EUS-LB) is an accepted technique for tissue acquisition. Traditionally, random LB has been performed with percutaneous (PC-LB) and transjugular (TJ-LB) approaches. The purpose of this study was to compare the safety profile and efficacy of EUS-LB, PC-LB, and TJ-LB. Patients and methods A retrospective analysis was performed at a tertiary academic medical center. Inclusion criteria for analysis were all adult patients who underwent EUS-LB since inception and TJ-LB/PC-LB over a 3-year span (June 2016 to June 2019). The primary outcome assessed was any adverse events. Secondary outcomes included technical success resulting in tissue acquisition and diagnostic adequacy of the sample for histologic analysis. Results A total of 513 patients were included for analysis. There were 135 EUS-LB, 287 PC-LB, and 91 TJ-LB. The most common indication for LB was abnormal liver function tests. For the primary outcome, the rate of adverse events was low with five reported (< 1 %). There were two in the EUS-LB group, two in the PC-LB group, and one in TJ-LB group, and this difference was not statistically significant (P = 0.585). The technical success rate was 100 % in each group. The rate of diagnostic adequacy was 100 % in TJ-LB group and 99 % in both EUS-LB and PC-LB groups. This difference was not statistically significant (P = 1.000). The most common histologic finding was non-specific changes (33.7 %) followed by non-alcoholic steatohepatitis (15.60 %). Conclusion In comparison with PC-LB and TJ-LB, EUS-LB has comparable safety profile, technical success rate, and diagnostic adequacy. EUS-LB should be considered as an option for random liver biopsy.

Diagnostic Yield of Endoscopic Ultrasound-Guided Liver Biopsy in Comparison to Percutaneous Liver Biopsy: A Two-Center Experience

“…Recent studies provided discording evidence on the comparative efficacy of EUS-LB as compared to PC-LB to diagnose parenchymal liver disease. In fact, while previous retrospective studies showed similar results between these two approaches [ 15 , 16 , 17 ], a recent small randomized-controlled trial (RCT) suggested better diagnostic performance with PC-LB [ 18 ].…”

Current state of endohepatology: Diagnosis and treatment of portal hypertension and its complications with endoscopic ultrasound

“…There were no statistically significant differences between modalities in regards to rates of adverse events, technical success rate, and diagnostic adequacy. Notably, the number of complete portal tracts for analysis and mean specimen length (two metrics for assessing specimen adequacy) were higher in the EUS-LB group compared to PC-LB and TJ-LB[ 13 ]. These results support comparable safety profile and diagnostic adequacy ( i.e., non-inferiority) of EUS-LB to current standard of care liver biopsy modalities.…”

Alternativen histologischer Materialgewinnung – Wann und wie ist die histologische Sicherung mittels Ultraschall (US), Computertomografie (CT) oder Endosonografie (EUS) sinnvoll?

“…Endosonografische und transjuguläre Biopsie sind nur im Einzelfall indiziert zur Abklärung generalisierter Leberparenchymerkrankungen. In der Literatur zeigen die Techniken eine vergleichbare Erfolgsrate [84]. Allerdings finden sich Hinweise auf unterschiedliche Risikoprofile mit etwas höherem Risiko für Blutungen durch perkutane Leberbiopsien und höherem Risiko für kardiale Komplikationen durch transjuguläre Biopsien [85].…”

“…Allerdings finden sich Hinweise auf unterschiedliche Risikoprofile mit etwas höherem Risiko für Blutungen durch perkutane Leberbiopsien und höherem Risiko für kardiale Komplikationen durch transjuguläre Biopsien [85]. Insbesondere unruhige Patienten und Patienten mit eingeschränkter Blutgerinnung können von diesen Alternativen profitieren [84,86,87]. [5,6,112].…”