Su1388 IS EUS GUIDED LIVER BIOPSY READY FOR PRIME TIME? YES

Abstract

Conventionally, liver biopsies have been performed via percutaneous and transjugular routes. Recently, endoscopic ultrasound (EUS) has been utilized to obtain core liver biopsies with varying success. One of the advantages of EUS-guided liver biopsy sampling (EUS-LB) is the ability to quickly and safely obtain liver passes from both lobes, thus minimize sampling error. Few studies have compared these methods of liver biopsies and have reached conflicting conclusions. We conducted a systematic review and meta-analysis to compare efficacy of EUS guided liver biopsies with both percutaneous and transjugular liver biopsies. We searched Medline, Embase, Scopus and Web of Science databases from January 2008 through November 11, 2017 to identify studies comparing EUS guided liver biopsy yield with percutaneous or transjugular methods. We also searched abstracts of Digestive Disease Week from 2008 to 2017 to increase our search yield. Main out of interest was mean number of complete portal triads. Mean differences (MD) between the three modalities were calculated and pooled using fixed effect model. Quality assessment was conducted using Newcastle Ottawa Scale (NOS). We included a total of 4 observational studies with 347 patients in this systematic review and meta-analysis. Among them, 184 underwent EUS guided biopsy, 104 got percutaneous and remaining 59 underwent transjugular biopsy. One study was rated as high quality while remaining 3 studies were rated as moderate quality as per NOS assessment. All transjugular biopsies were performed with 21 G needle, percutaneous biopsies were performed with 18 G needles, while EUS guided biopsies could be performed with Shark Core needle 19G, FNA needle 19G or Procore needle 19G. Mean number of passes required by EUS was 2.6±1.1. Pooled MD with 95% confidence interval (CI) while comparing EUS with percutaneous biopsy was -1.65 (-3.03, -0.26), I2=0% in favor of EUS. Pooled MD while comparing EUS with transjugular biopsy was -4.05 (-7.82, -0.27) in favor of EUS with no heterogeneity. There was no bleeding reported in any of the 184 patients who underwent EUS guided liver biopsies. EUS guided liver biopsy is superior to the conventional percutaneous and transjugular biopsies and may become the diagnostic method of choice when biopsy is required. No adverse events related to bleeding or pain were reported in the EUS group.View Large Image Figure ViewerDownload Hi-res image Download (PPT)