Endoscopic Ultrasound-Guided Liver Biopsy (EUS-LB) versus Percutaneous Liver Biopsy (PC-LB): The Battle of Supremacy for Liver Tissue Accusation

Aim and objective: The gold standard route for liver biopsy is percutaneous liver biopsy. Endoscopic ultrasound-guided liver biopsy (EUS-LB) is now increasingly being used across the globe as a method of liver tissue acquisition. This method is widely accepted by many professionals as it can overcome many shortcomings of percutaneous liver biopsy and transjugular liver biopsy. Aim of the study is to compare the EUS-LB and percutaneous liver biopsy in terms of adequate and optimal biopsy rate.

Materials and Methods: This is a retrospective observational study. Consecutive patients undergoing EUS-LB and PC-LB during the study period were taken up for the study. Adequacy of tissue diagnosis and adverse events were compared between the two groups.

Results: A total of 91 patients were in EUS-LB group and 97 in PC-LB group. Both groups were age- and sex-matched. Total specimen length (TSL) and number of complete portal tract (CPT) were more in EUS-LB group than in PC-LB group (4.1 vs. 2.7 cm with p-value of 0.000 and 12.7 versus 8.1 with p-value of 0.000, respectively). Adequate biopsy rate (according to EASL criteria) and optimal biopsy rate (according to AASLD criteria) were 89% (81/91) and 60.4% (55/91) in EUS-LB group and 75.3% (73/97) and 16.5(16/97) % in percutaneous liver biopsy group, respectively. Rate of conclusive diagnosis was 95.6% (86/91) in EUS-LB group and 93.8% (91/97) in percutaneous liver biopsy group. Additional diagnostic information was obtained by endosonography during EUS-LB in 21 patients (23.1%). Adverse events were seen in 6.2% of PC-LB group (minor complication (pain) 6/97) compared to 0% (0/91) in EUS-LB group. Minor bleeding was seen in one patient of PC-LB group.

Conclusion: This study has the large sample size in comparing EUS-LB and PC-LB and it is the first study from India comparing the same. TSL, CPT, optimal biopsy rate, rate of conclusive diagnosis, and adequate biopsy rate were more in EUS-LB group than PC-LB group and it was statistically significant in favor of EUS-LB. EUS-LB can achieve excellent histological yield when performed with optimal technique. Moreover, it is possible to obtain additional information during the procedure from diagnostic endosonography which is done as a part of EUS-LB. Procedure-related adverse events were also less in favor of EUS-LB. In short EUS-LB is the clear-cut winner of battle of supremacy for liver tissue accusation and future studies holds the key for confirmation of the same.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
22 April 2024