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Performance of Endoscopic Ultrasound-Guided Versus Percutaneous Liver Biopsy in Diagnosing Stage 3–4 Fibrosis

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An Invited Commentary to this article was published on 04 August 2023

Abstract

Background

Percutaneous liver biopsy (P-bx) is the gold standard for diagnosing advanced fibrosis. Despite the proven technical feasibility of EUS-guided liver bx (EUS-bx) as a novel alternative way of liver biopsy, the clinical applicability remains to be determined.

Aims

The primary aim of this study is to evaluate if EUS-bx, compared to P-bx, can effectively and safely obtain adequate specimen and accurately predict hepatic fibrosis.

Methods

This is a single center, retrospective chart review among patients with liver diseases at a tertiary endoscopy center from February 2011 to March 2020. We assessed the EUS-bx versus P-bx outcomes by success rate, performance, and safety profile. The primary outcome was the association between EUS-bx clinical variables and the presence of histologic liver fibrosis stage ≥ 3. The secondary outcomes were the associations between EUS-bx and variables indicative of fibrosis.

Results

Fifty-nine patients underwent EUS-bx; and 59, P-bx. All EUS-bx procedures were successfully completed. All 56/56 (100%) of EUS-bx vs. 50/52 (96.2%) P-bx were considered adequate samples. Tissue lengths were significantly longer in the EUS-bx cohort (p < 0.0001) with a trend towards a greater number of portal tracts. 46/56 (82.1%) cases of EUS-bx vs. 32/52 (61.5%) of P-bx had > 10 portal tracts; 21/56 (37.5%) cases of EUS-bx vs. 14/52 (26.9%) of P-bx had > 15 portal tracts. There were 6 (10.2%) EUS-bx vs. 1 (1.7%) P-bx related complication leading to a phone call (p = 0.061).

Conclusions

EUS-bx can safely performed and accurately predict liver fibrosis stage as the standard P-bx without being influenced by procedure-related factors.

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Abbreviations

HVPG:

Hepatic venous pressure gradient

EUS-PPG:

EUS-guided portal pressure gradient measurement

EUS-bx:

EUS-guided liver biopsy

EV:

Esophageal varices

GV:

Gastric varices

PHG:

Portal hypertensive gastropathy

CTP:

Child-Turcotte Pugh

MELD:

Model for end-stage liver disease

APRI:

AST to platelet ratio index

FIB-4:

Fibrosis-4

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Funding

This was an investigator initiated study, and there was no funding for this study.

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Authors and Affiliations

  1. Division of Gastroenterology/Hepatology, University of California, Irvine, School of Medicine, Orange, CA, USA

    Alyssa Y. Choi, Jason Samarasena, John G. Lee, Kenneth J. Chang & Ke-Qin Hu

  2. Department of Pathology, University of California, Irvine, School of Medicine, Orange, CA, USA

    Xiaodong Li, Wenchang Guo & Vishal S. Chandan

Authors
  1. Alyssa Y. Choi
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  2. Xiaodong Li
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  3. Wenchang Guo
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  4. Vishal S. Chandan
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  5. Jason Samarasena
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  6. John G. Lee
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  7. Kenneth J. Chang
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  8. Ke-Qin Hu
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Contributions

AYC: data collection, manuscript preparation and review. XL: review of pathology. WG: review of pathology, manuscript review. VC: review of pathology, manuscript review. JS: procedure performed, manuscript review. JL: procedure performed, manuscript review. KC: procedure performed, manuscript review. K-QH: Study design, statistical analysis, manuscript preparation and review.

Corresponding author

Correspondence to Ke-Qin Hu.

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Conflict of interest

All authors have no conflicts of interest to disclose related to this study.

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Choi, A.Y., Li, X., Guo, W. et al. Performance of Endoscopic Ultrasound-Guided Versus Percutaneous Liver Biopsy in Diagnosing Stage 3–4 Fibrosis. Dig Dis Sci 68, 3774–3780 (2023). https://doi.org/10.1007/s10620-023-08019-8

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  • DOI: https://doi.org/10.1007/s10620-023-08019-8

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