Endoscopic Ultrasonography (EUS)-Guided Liver Biopsy for the Diagnosis of Liver Parenchymal Diseases: A Systematic Review and Meta-Analysis

Abstract

Introduction: Endoscopic ultrasonography (EUS)-guided liver biopsy is a novel technique to obtain adequate liver sample for diagnosis of liver parenchymal diseases. There are studies that evaluated the feasibility and safety and EUS-guided liver biopsy, however factors that influence specimen quality is yet to be determined. Methods: We performed a detailed search of PubMed, MEDLINE and Web of ScienceTMdatabases to identify studies in which results of EUS-guided liver parenchymal biopsies were reported published up to March 2018. A random-effects model was used to estimate pooled values (mean ± SE) for total specimen length (TSL) and complete portal tracts (CPT). Subgroup analyses were applied to find out the procedural factors associated with better specimen quality using Cochrane's Q test. Results: Ten studies with a total of 451 patients included in the meta-analysis. Overall pooled mean TSL and CPT were 33.2 ± 5.6 and 11.9 ± 1.9, respectively. In subgroup analysis, fine-needle biopsy (FNB) proved to better in terms of TSL and CPT than EUS-guided tru-cut biopsies (TSL; 46.8 ± 5.9 vs 13.6 ± 6.9 mm, p<0.001; CPT; 15.5 ± 2.1 vs 2.67 ± 3.24, p<0.001). FNB with slow-pull or suction technique provided a similar TSL (TSL; 64.3 ± 22.3 vs 52.4 ± 10.9 mm, p=0.63), however slow-pull technique was better in terms of CPT (34.5 ± 6.9 vs 17.1 ± 3.2, p=0.02). Standard versus core-type needle had comparable results in terms of TSL and CPT. Conclusion: EUS-guided parenchymal liver biopsy is a good alternative to other methods of liver sampling. Using FNB needles with a slow-pull technique can provide better results.961_A Figure 1. Overall Pooled Analysis for Total Specimen Length (TSL)961_B Figure 2. Overall Pooled Analysis for Complete Portal Tracts (CPT)