Clin Endosc.  2020 Sep;53(5):583-593. 10.5946/ce.2019.211.

Endoscopic Ultrasound-Guided, Percutaneous, and Transjugular Liver Biopsy: A Comparative Systematic Review and Meta-Analysis

• McCarty TR
• Bazarbashi AN
• Njei B
• Ryou M
• Aslanian HR
• Muniraj T

• KMID: 2507593
• DOI: http://doi.org/10.5946/ce.2019.211

Abstract

Background/Aims
Percutaneous liver biopsy (PCLB) or transjugular liver biopsy (TJLB) have traditionally been performed to obtain a sample of hepatic tissue; however, endoscopic ultrasound-guided liver biopsy (EUSLB) has become an attractive alternative. The aim of this study was to compare the efficacy and safety of EUSLB, PCLB, and TJLB.
Methods
Search strategies were developed in accordance with PRISMA and MOOSE guidelines. Major outcomes included the following: adequacy of biopsy specimens (i.e., complete portal triads [CPT], total specimen length [TSL] in mm, and length of longest piece [LLP]) in mm), and rate of adverse events. Only studies comparing all biopsy approaches (i.e., EUSLB, PCLB, and TJLB) were included.
Results
Five studies (EUSLB [n=301]; PCLB [n=176]; and TJLB [n=179]) were included. Biopsy cumulative adequacy rates for EUSLB, PCLB, and TJLB were 93.51%, 98.27%, and 97.61%, respectively. Based on the subgroup analysis limited to EUS biopsy needles in current clinical practice, there was no difference in biopsy adequacy or adverse events for EUSLB compared to PCLB and TJLB (all p>0.050). A comparison of EUSLB and PCLB revealed no difference between specimens regarding both CPT (p=0.079) and LLP (p=0.085); however, a longer TSL (p<0.001) was observed. Compared to TJLB, EUSLB showed no difference in LLP (p=0.351), fewer CPT (p=0.042), and longer TSL (p=0.005).
Conclusions
EUSLB appears to be a safe, minimally invasive procedure that is comparable to PCLB and TJLB regarding biopsy specimens obtained and rate of adverse events associated with each method.

Keyword

Endoscopic ultrasound (EUS); Interventional endoscopy; Liver biopsy

Figure

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  Fig. 1. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow chart of search results.

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  Fig. 2. (A) Cumulative liver biopsy adequacy for endoscopic ultrasound-guided liver biopsy. (B) Cumulative liver biopsy adequacy for percutaneous liver biopsy. (C) Cumulative liver biopsy adequacy for transjugular liver biopsy. CI, confidence interval.

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  Fig. 3. (A) Forest plot: comparison of complete portal triads for endoscopic ultrasound-guided liver biopsy (EUSLB) versus percutaneous liver biopsy (PCLB). (B) Forest plot: comparison of length of longest piece for EUSLB versus PCLB. (C) Forest plot: comparison of total specimen length for EUSLB versus PCLB. CI, confidence interval.

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  Fig. 4. (A) Forest plot: comparison of length of longest piece for for endoscopic ultrasound-guided liver biopsy (EUSLB) versus transjugular liver biopsy (TJLB). (B) Forest plot: comparison of complete portal triads for EUSLB versus TJLB. (C) Forest plot: comparison of total specimen length for EUSLB versus TJLB. CI, confidence interval.

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