The Role of EUS in Liver Biopsy

  • Shaffer R. S. Mok
  • David L. DiehlEmail author
Pancreas and Biliary Tract (O Haluszka, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Pancreas and Biliary Tract


Purpose of Review

EUS-guided liver biopsy (EUS-LB) is being used with increased frequency to perform parenchymal liver biopsy. Evolution of the technique can now achieve excellent liver tissue cores. This review covers important developments in this procedure.

Recent Findings

Clinical studies have recently demonstrated that the 19G EUS core biopsy needle is superior to non-core needles for liver tissue acquisition. In addition, wet suction provides more robust tissue samples than dry suction. Heparin priming of the needle (instead of saline) can prevent blood clogging within the needle lumen. A 1-hour recovery time after the EUS-LB is sufficient in almost all cases. The EUS-LB can deliver bilobar biopsies, which can decrease sampling error. Patients who need a liver biopsy in addition to an endoscopy or EUS are best served by the EUS-LB, as the combination procedure saves time and cost.


The EUS-LB is a safe and effective means for procuring good liver core biopsies. Incremental improvements in technique have increased quality of the resulting specimen. Future directions of this technique are discussed.


Liver biopsy Endoscopic ultrasound Fine needle biopsy Non-alcoholic steatohepatitis 



Endoscopic ultrasound


Endoscopic ultrasound–guided liver biopsy


Fine needle aspiration


Fine needle biopsy




Liver biopsy


Non-alcoholic fatty liver disease




Compliance with Ethical Standards

Conflict of Interest

David Diehl reports working as a consultant for Boston Scientific, Medtronic, Olympus America, and Cook Medical. Shaffer Mok reports working as a consultant for Medtronic and grants from Pentax/C2 Therapeutics, outside the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Case Western Reserve University—School of MedicineClevelandUSA
  2. 2.Department of Gastroenterology and NutritionGeisinger Medical CenterDanvilleUSA

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