The efficacy and safety of endoscopic ultrasound-guided liver biopsy versus percutaneous liver biopsy in patients with chronic liver disease: a retrospective single-center study

Abstract

Background and aims: There is limited literature on endoscopic ultrasound-guided liver biopsy (EUS-LB), a new method of obtaining liver biopsy (LB).

Methods: We conducted a retrospective study of the efficacy and safety of EUS-LB compared to percutaneous liver biopsy (PC-LB) in patients with chronic liver disease at our center between January 2018 and August 2019.

Results: Thirty patients underwent EUS-LB and 60 patients underwent PC-LB were identified (median follow-up post-LB was 8 days; interquartile range (IQR), 3-5 days). The median number of portal tracts was significantly higher in the PC-LB group (13 vs. 5; P < 0.0001). A histologic diagnosis was established in 93% of the EUS-LB group, compared to 100% in the PC-LB group (P = 0.841). Patients in EUS-LB group had significantly shorter hospital stay (median time of hospital stay was 3 vs. 4.2 h in the EUS-LB vs. PC-LB group, respectively; P = 0.004) and reported less pain compared to PC-LB group (median pain score was 0 vs. 3.5; P = 0.0009). EUS-LB were performed using a 19-gauge (n = 27) or 22-gauge (n = 3); there was a tendency towards higher number of portal tracts in the 22- vs. the 19-gauge needle group (6 vs. 5; P = 0.501). No patient in either group had significant adverse events such as bleeding or death.

Conclusion: EUS-LB is safe and is associated with less pain, shorter hospital stay, and high diagnostic yield (93%) compared to PC-LB. Randomized trials are needed to standardize the utility of EUS-LB.

Keywords: Chronic liver disease; Endoscopic ultrasound-guided liver biopsy; Percutaneous liver biopsy.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1

a Linear echoendoscope showing the right lobe of the liver. b Linear echoendoscope showing fine needle biopsy of the right lobe of the liver using 19-gauge fork-tip needle

Fig. 2

a and b Multiple cores of liver tissue obtained by EUS-FNB placed in a formalin jar. c Multiple cores of liver tissue obtained by EUS-FNB separated from blood clots

Fig. 3

Comparison between the number of portal tracts (a), core biopsy length (b), length of hospital stay (c), and maximum pain in the PC-LB (n = 60) vs. the EUS-LB (n = 30) groups. Descriptive statistics are expressed as median (interquartile range)

Fig. 4

a Linear regression showing the relationship between the number of portal tracts per subject and the core biopsy length in the entire sample; b number of portal tracts per subject and the core biopsy length in the PC-LB group; c number of portal tracts per subject and core biopsy length in the EUS-LB group; d relationship between age and number of portal tracts per subject in the EUS-LB group; and e relationship between age and number of portal tracts per subject in the PC-LB group