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

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Abstract

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.

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Authors and Affiliations

  1. Koc University School of Medicine, Istanbul, Turkey

    Bulent Baran

  2. Nassau University Medical Center, East Meadow, NY, USA

    Santosh Kale

  3. UTHealth McGovern Medical School, Houston, TX, USA

    Prithvi Patil, Srinivas Ramireddy, Ricardo Badillo, Roy Tomas DaVee & Nirav Thosani

  4. University of Arizona, Tucson, AZ, USA

    Bijun Kannadath

  5. Center for Interventional Gastroenterology at the University of Texas (iGUT), McGovern Medical School at UTHealth, 6400 Fannin, Suite 1400, Houston, TX, 77030, USA

    Prithvi Patil, Bijun Kannadath, Srinivas Ramireddy, Ricardo Badillo, Roy Tomas DaVee & Nirav Thosani

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  1. Bulent Baran
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Correspondence to Nirav Thosani.

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Disclosures

Dr. Nirav Thosani reports other from Boston Scientific, other from Medtronic, primarily as a consultant outside the submitted work. Drs. Bulent Baran, Santosh Kale, Prithvi Patil, Bijun Kannadath, Srinivas Ramireddy, Ricardo Badillo and Tomas Davee have no conflicts of interest or financial ties to disclose.

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464_2020_8053_MOESM1_ESM.tif

Supplementary figure 1. Forrest plots for (a) total specimen length (TSL) and (b) complete portal tracts (CPT) for comparison of suction vs no suction techniques. (TIF 137 kb)

Supplementary file2 (TIF 141 kb)

464_2020_8053_MOESM3_ESM.tif

Supplementary figure 2. Forrest plots for (a) total specimen length (TSL) and (b) complete portal tracts (CPT) for comparison of 19G vs 22G EUS needles. (TIF 139 kb)

Supplementary file4 (TIF 135 kb)

464_2020_8053_MOESM5_ESM.tif

Supplementary figure 3. Forrest plots for (a) total specimen length (TSL) and (b) complete portal tracts (CPT) for comparison of novel core needles. (TIF 75 kb)

Supplementary file6 (TIF 80 kb)

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Baran, B., Kale, S., Patil, P. et al. Endoscopic ultrasound-guided parenchymal liver biopsy: a systematic review and meta-analysis. Surg Endosc 35, 5546–5557 (2021). https://doi.org/10.1007/s00464-020-08053-x

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