Endoscopic ultrasound-guided parenchymal liver biopsy: a systematic review and meta-analysis

Bulent Baran, Santosh Kale, Prithvi Patil, Bijun Kannadath, Srinivas Ramireddy, Ricardo Badillo, Roy Tomas DaVee, Nirav Thosani

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


Background: Endoscopic ultrasonography (EUS)-guided liver biopsy is a novel technique to obtain adequate liver samples for diagnosis of liver parenchymal diseases. There are studies that have evaluated the feasibility and safety of EUS-guided parenchymal liver biopsy (EUS-LB), however, factors that can influence specimen quality are yet to be determined. Our aim was to determine the diagnostic accuracy of EUS-LB and evaluate factors associated with specimen quality. Methods: We performed a detailed search of PubMed/MEDLINE and Web of Science™ databases to identify studies in which results of EUS-guided liver parenchymal biopsies were reported published up to July 2020. 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 Cochran’s Q test. A total of 10 meta-analyses were done focusing on international studies. Total of 1326 patients who underwent EUS-LB. EUS-LBs performed for suspicion of parenchymal liver disease. Pooled mean values for TSL and CPT with subgroup analyses. Results: Twenty-three studies with a total of 1326 patients were included in our meta-analysis. Overall pooled mean TSL and CPT were 45.3 ± 4.6 mm and 15.8 ± 1.5, respectively. In subgroup analysis, core biopsy needles proved to better in terms of CPT than fine-needle aspiration needles (18.4 vs 10.99, p = 0.003). FNB with slow-pull or suction technique provided a similar TSL (44.3 vs 53.9 mm, p = 0.40), however, slow-pull technique was better in terms of CPT (30 vs 14.6, p < 0.001). Heterogeneity was present among the studies. Another limitation is the low number randomized control trials. 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.

Original languageEnglish (US)
Pages (from-to)5546-5557
Number of pages12
JournalSurgical endoscopy
Issue number10
StatePublished - Oct 2021


  • Endoscopic ultrasonography
  • Fine-needle biopsy
  • Liver biopsy
  • Liver histology
  • Liver parenchymal disease

ASJC Scopus subject areas

  • Surgery


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