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World J Gastroenterol. Jul 28, 2022; 28(28): 3586-3594
Published online Jul 28, 2022. doi: 10.3748/wjg.v28.i28.3586
Update on endoscopic ultrasound-guided liver biopsy
Shiva Rangwani, Devarshi R Ardeshna, Khalid Mumtaz, Sean G Kelly, Samuel Y Han, Somashekar G Krishna
Shiva Rangwani, Devarshi R Ardeshna, Khalid Mumtaz, Sean G Kelly, Samuel Y Han, Somashekar G Krishna, Division of Gastroenterology, Hepatology, and Nutrition,Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Author contributions: Rangwani S and Ardeshna DR performed the majority of the literature search, writing, and preparation of tables; Mumtaz K, Kelly SG, and Han SY reviewed the final manuscript; Krishna SG provided figures, input in the writing process, and review of the final manuscript.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Somashekar G Krishna, AGAF, FACG, FASGE, MD, Professor, Division of Gastroenterology, Hepatology, and Nutrition, Ohio State University Wexner Medical Center, 395 W 12th Avenue, Suite 262, Columbus, OH 43210, United States. somashekar.krishna@osumc.edu
Received: January 16, 2022
Peer-review started: January 16, 2022
First decision: March 8, 2022
Revised: April 21, 2022
Accepted: June 23, 2022
Article in press: June 23, 2022
Published online: July 28, 2022
Abstract

Endoscopic ultrasound guided liver biopsy (EUS-LB) has emerged as a minimally-invasive alternative to the traditional (percutaneous or transjugular) liver biopsy techniques for the diagnosis of liver parenchymal diseases. Po-tentially, EUS-LB combines the advantages of percutaneous and transjugular liver biopsy in addressing focused sampling in addition to measuring portal pressure. Additionally, EUS-LB facilitates access to both the lobes of the liver which is not considered with the traditional percutaneous liver biopsy. Multiple studies have compared EUS-LB with conventional liver biopsy and reported comparable diagnostic yield, increased acquisition of complete portal tracts, and longer specimen length as compared to the traditional approaches. EUS-LB is associated with lesser post-procedural pain and shorter recovery time, while providing lower risk of complications when compared to traditional liver biopsy. Innovations in needle types, needle sizes and suction techniques have aimed at further optimizing the EUS-LB technique. This review article updates current literature with focus on the variations in the technique and equipment used for EUS-LB, and compares EUS-LB with traditional methods of liver biopsy.

Keywords: Endoscopic ultrasound guided liver biopsy, Liver biopsy, Percutaneous liver biopsy, Transjugular liver biopsy, Liver parenchymal disease, Portal pressure gradient

Core Tip: Endoscopic ultrasound guided liver biopsy (EUS-LB) has emerged as a minimally invasive alternative to the traditional (percutaneous or transjugular) liver biopsy techniques for the diagnosis of liver parenchymal diseases. EUS-LB facilitates access to both the lobes of the liver and allows measurement of portal pressure. EUS-LB has comparable diagnostic accuracy, increased yield of complete portal tracts, and longer specimen length compared to the traditional approaches. Innovations in needle technology and variations in suction have further optimized the EUS-LB technique. This review article updates current literature comparing EUS-LB to traditional liver biopsy and advances in this field.