Review
Copyright ©The Author(s) 2020.
World J Gastrointest Endosc. Mar 16, 2020; 12(3): 83-97
Published online Mar 16, 2020. doi: 10.4253/wjge.v12.i3.83
Table 1 Advantages and disadvantages of liver biopsy methods
Percutaneous liver biopsyTransjugular liver bipsySurgeryEndoscopic ultrasound guided liver biopsy
IndicationMainstay method of liver biopsy for unexplained abnormal LFTs, assessing, staging, diagnosing liver diseaseCoagulopathy; ascites; morbid obesity; failure of percutaneous liver biopsy ; thrombocytopeniaUndergoing surgery for another indicationUndergoing endoscopy for another indication
ComplicationsPain; hemorrhage; peritonitis; hypotension; infection; gallbladder perforation; pneumothorax; hemothoraxHemorrhage; pain capsule perforation; arterial aneurysms; arrhythmiasHemorrhage, abdominal wall injury; intraperitoneal injury; anesthesia related complicationsHemorrhage; abdominal pain; infection
AdvantageWell-known procedure; cost effective; less technical skills requiredDecreased risk of complications; more tolerable; useful in patients with comorbiditiesCan take LB while performing another procedureIncreased tolerability; decreased recovery time; decreased complications; bi-lobar access; decreased sampling variability; View anatomical/vascular structures
DisadvantageIncreased sampling variability; less tolerable; require more passes; increased risk of complicationsLimited view of liver parenchyma and vascular anatomy; increased sample fragmentationInvasive; requires surgical specialtyCostly, if not performed along with another endoscopic procedure
Table 2 Comprehensive review of studies on endoscopic ultrasound guided liver biopsy
Ref.Study designnIndicationNeedle usedNo of passesCPTsTSLInsufficient sampleAdverse events
Wiersema et al[70], 2002Prospective cohort9No medical indication19G Tru-cutNR14 mm0None
Gleeson et al[54], 2008Retrospective case series9Hepatic parenchymal disease19G Tru-cut2716.9 mm0None
DeWitt et al[71], 2009Prospective case series21Hepatic parenchymal disease19G Tru-cut329 mm10%None
Stavropoulos et al[55], 2012Prospective case series22Abnormal LFTs19G FNA (non-Tru-cut)2936.9 mm9%None
Gor et al[73], 2014Prospective case series10Abnormal LFTs; Suspected cirrhosis19G FNA (non-Tru-cut)39.214.4 mm0None
Diehl et al[51], 2015Retrospective cohort110Persistent transaminitis19G FNA Expect Flexible1 to 21438 mm2%Self-limited bleeding
Lee et al[67], 2015Prospective cohort21Rescue for PCLB22G FNB, 25G FNB2NRNR9.50%None
Pineda et al[66], 2016Retrospective cohort110Abnormal LFTs of Unknown Etiology19G FNA Expect/Flexible31438 mm2%NR
Sey et al[72], 2016Prospective Cross-sectional75Suspected parenchymal disease19G FNB ProCore; 19G FNB Tru-Cut2; 35; 220 mm; 9 mm3%; 27%None; Pain
Schulman et al[79], 2017Prospective ex-vivo48No medical indication18G1 (percutaneous); 18G2 (percutaneous); 19G FNA Expect; 19G FNB ProCore; 19G FNB SharkCore; 22G FNB SharkCore1 to 22.5; 3.5; 1.9; 1.7; 6.2; 3.8NR; NR; NR; NR; NR; NR16.7%; 18.7%; 54%; 81%; 14.6%; 14.6%None
Mok et al[53], 2017Prospective cross-over20Elevated LFT Unknown Etiology19G FNB; 22G FNB SharkCoreNR7.4; 6.176.5 mm; 66.9 mm2.5%; 2.5%None; Pain
Shah et al[75], 2017Retrospective chart review24Abnormal LFTs, pancreaticobiliary disease19G FNB SharkCore232.565.6 mm4%Pain; Subcapsular bleeding
Saab et al[87], 2017Retrospective chart review47Biliary tract disease, abnormal LFTs19G FNB SharkCoreNR1865 mm0Self-limited liver; hematomas
Ching-Companioni et al[83], 2018Prospective randomized40Abnormal LFTs19G FNA Expect Flexible; 19G FNB Acquire1; 138; 16.511.8 mm; 16.3 mm0Pain
Nieto et al[76], 2018Prospective observational165Unexplained abnormal LFTs, biliary obstruction19G FNB SharkCore11860 mm0Abdominal pain; Self-limited hematoma
Mok et al[80], 2018Prospective cross-over40Parenchymal liver disease19G FNA Expect Flexible; 19G FNA Expect Flexible; 19G FNA Expect Flexible34; 4; 723.9 mm; 29.7 mm; 49.2 mm20%; 7%; 2%Postprocedural bleeding
Rombaoa et al[69], 2018Retrospective chart review8Unexplained abnormal LFTs, hepatitis B staging, cirrhosis19G FNB Acquire29.4NRNRNone
Shuja et al[68], 2019Retrospective observational cohort69NASH fibrosis staging19G FNA Expect Flexible310.8445.8 mmNRNone
Hasan et al[77], 2019Prospective nonrandomized trial40Elevated liver enzymes22G FNB Acquire2 L; 1 R4255 mm0Self-limiting abdominal pain
Bazerbachi et al[78], 2019Prospective cohort41NAFLD diagnosis, staging22G FNB Fork-tip22624 mm0Postprocedural pain
Table 3 Summary of society guidelines for adequate liver biopsy
Medical societyTotal specimen lengthComplete portal triadsNeedle size
American Association for the Study of Liver Diseases2-3 cm≥ 1116G
European Association for the Study of the Liver15 mm--
Asian Pacific Association for the Study of the Liver15 mm≥ 1016G