EUS-guided versus percutaneous liver biopsy: A comprehensive review and meta-analysis of outcomes

Saurabh Chandan, Smit Deliwala, Shahab R Khan, Babu P Mohan, Banreet S Dhindsa, Jay Bapaye, Hemant Goyal, Lena L Kassab, Faisal Kamal, Harlan R Sayles, Gursimran S Kochhar, Douglas G Adler, Saurabh Chandan, Smit Deliwala, Shahab R Khan, Babu P Mohan, Banreet S Dhindsa, Jay Bapaye, Hemant Goyal, Lena L Kassab, Faisal Kamal, Harlan R Sayles, Gursimran S Kochhar, Douglas G Adler

Abstract

EUS-guided liver biopsy (EUS-LB) has gained momentum in recent years, especially with availability of newer needle designs. Given the emerging comparative data on EUS-LB with second-generation needles and percutaneous LB (PC-LB), we conducted a systematic review and meta-analysis to compare the safety and efficacy of the two techniques. We searched multiple databases from inception through November 2021 to identify studies comparing outcomes of EUS-LB and PC-LB. Pooled estimates were calculated using a random-effects model, and the results were expressed in terms of pooled proportions and odds ratio (OR) along with relevant 95% confidence intervals (CIs). Five studies with 748 patients were included in the final analysis. EUS-LB was performed in 276 patients and PC-LB in 472 patients. Across all studies, PC-LB had an overall higher diagnostic accuracy than EUS-LB, 98.6% confidence interval (CI: 94.7-99.7) versus 88.3% (49.6-98.3), OR: 1.65, P = 0.04. On assessing data from randomized controlled trials, there was no difference between the two. While pooled diagnostic adequacy and overall adverse events were not significantly different between PC-LB and EUS-LB, the former was superior in terms of the mean number of complete portal tracts (CPT) and total specimen length. PC-LB and EUS-LB produce similar results. PC-LB allows obtaining longer samples and more CPT. Further studies are needed to see if these trends hold up as more providers begin to perform EUS-LB.

Keywords: EUS; liver biopsy; meta-analysis.

Conflict of interest statement

None

Figures

Figure 1
Figure 1
Forest plot, OR, diagnostic adequacy. EUS-LB: EUS-guided liver biopsy; PC-LB: Percutaneous liver biopsy; CI: Confidence interval; OR: Odds ratio; RCT: Randomized controlled trial
Figure 2
Figure 2
Forest plot, OR, diagnostic accuracy. EUS-LB: EUS-guided liver biopsy; PC-LB: Percutaneous liver biopsy; CI: Confidence interval; OR: Odds ratio; RCT: Randomized controlled trial
Figure 3
Figure 3
Forest plot, OR, overall adverse events. EUS-LB: EUS-guided liver biopsy; PC-LB: Percutaneous liver biopsy; CI: Confidence interval; OR: Odds ratio
Figure 4
Figure 4
Forest plot, OR, mean complete portal tracts. EUS-LB: EUS-guided liver biopsy; PC-LB: Percutaneous liver biopsy; CI: Confidence interval; OR: Odds ratio
Figure 5
Figure 5
Forest plot, OR, total specimen length. EUS-LB: EUS-guided liver biopsy; PC-LB: Percutaneous liver biopsy; CI: Confidence interval; OR: Odds ratio; RCT: Randomized controlled trial

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