Feasibility and safety of endoscopic ultrasound-guided liver biopsy to diagnose parenchymal liver disease: A multi-centre retrospective cohort study

Abstract

Background: Liver biopsy is an important diagnostic tool to investigate patients with suspected liver disease. The efficacy and safety of endoscopic ultrasound-guided liver biopsy (EUS-LB) as a method for liver tissue acquisition remain uncertain.

Aim: To study the diagnostic yield and safety of EUS-LB in patients with suspected parenchymal liver disease.

Methods: This is a retrospective observational cohort study of patients undergoing EUS-LB in 2 tertiary-care centers in Kuwait in the period between January 2022-June 2025. The primary outcome was sample adequacy, while secondary outcomes included histological quality of the specimen and adverse events. Predictors of increased diagnostic adequacy and specimen quality were explored.

Results: A total of 50 patients [mean age 43.9 (15.5) years, 40% males] were included. The left liver lobe was targeted for biopsy in most patients (96%), and 19-gauge fine needle aspiration (FNA) was used in most cases (52%). The median number of passes performed was 3 (range 2-5), and the heparin-wet suction technique was used in 40% of patients. The overall diagnostic adequacy of EUS-LB was 86%, with no significant difference between 19-gauge FNA and 19-gauge fine needle biopsy (FNB) needles. Fulfillment of the European Association for the Study of Liver (EASL) and the American Association for the Study of Liver Diseases criteria was achieved in 54% and 34%, respectively, with a significantly higher number of patients fulfilling these criteria when FNB needle was used compared to FNA needle (83.3% vs 26.9%, P < 0.0001) and (62.5% vs 7.7%, P < 0.0001), respectively. Only 1 patient (2.0%) developed adverse post-procedure events, namely bleeding requiring transfusion. Multivariate regression analysis did not identify any factor that increased diagnostic adequacy; however, the use of FNB needles and wet heparin suction methods were associated with significantly increased odds of fulfilling EASL criteria, while performing more than 2 passes reduced the quality of the specimen.

Conclusion: EUS-LB is an effective and safe method for obtaining liver biopsy in patients with suspected parenchymal liver disease. EUS-LB demonstrated a favorable safety profile in our cohort, although larger prospective studies are required to validate bleeding risk. The use of 19-gauge FNB needles, wet-heparin suction technique, and performing ≤ 2 passes is associated with improved quality of the specimen obtained without increasing the risk of adverse events.

Keywords: Endoscopic ultrasound; Fine needle aspiration; Fine needle biopsy; Liver biopsy; Parenchymal liver disease.