Advances in Endoscopic Ultrasound (EUS)-Guided Liver Biopsy

Abstract

Recent years have seen the emergence of endoscopic-ultrasound-guided liver biopsy (EUS-LB) as an effective alternative to traditional (percutaneous or transjugular) liver biopsy techniques. Comparative studies have demonstrated that both endoscopic and non-endoscopic approaches are similar in terms of diagnostic adequacy, accuracy, and adverse events; however, EUS-LB offers the advantage of reduced recovery time. Additionally, EUS-LB enables the sampling of both lobes of the liver as well as the advantage of portal pressure measurements. However, EUS-LB may be argued to have a high cost, although this procedure can be cost-effective if bundled with other endoscopic procedures. Approaches utilizing EUS-guided liver therapy, such as the administration of chemotherapeutic agents and EUS elastography, are in development, and their optimal integration into clinical care is likely to emerge in the coming years. In the present review, we evaluate the available literature on EUS-LB indications, contraindications, variations in needle biopsy techniques, comparative outcomes, advantages and disadvantages, and future trends and perspectives.

Keywords: endoscopic ultrasound; endoscopy; liver biopsy; percutaneous liver biopsy.

Figure 1

Illustration of bedside percutaneous liver biopsy.

Figure 2

Illustration of a transjugular approach for liver biopsy.

Figure 3

Illustration of endoscopic-ultrasound-guided liver biopsy.

Figure 4

(A)—endoscopic ultrasound image of the liver with doppler. (B)—endoscopic-ultrasound-guided liver biopsy using a 19 G needle.