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

1 Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, USA
2 Department of Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
3 Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
4 Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
5 Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
6 Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
7 Department of Gastroenterology, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA
8 Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
9 Division of Gastroenterology, University of California-San Francisco, California, USA
10 Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
11 Division of Gastroenterology, Hepatology and Nutrition, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
12 Center for Advanced Therapeutic Endoscopy, Centura Health, Porter Adventist Hospital, Denver, Colorado, USA

Correspondence Address:
Douglas G Adler,
Center for Advanced Therapeutic Endoscopy, Centura Health, Porter Adventist Hospital, Denver, Colorado
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/EUS-D-21-00268

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.

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