For the evaluation of subacute and chronic liver diseases, optimal liver biopsy (LB) specimens can be obtained more reliably and at a lesser cost using traditional percutaneous (PC) methods as compared with endoscopic ultrasound (EUS)-based methods, according to a study published in Gut.

LBs are being increasingly performed under EUS guidance for the procurement of liver tissue to assess for parenchymal disease. However, there are limited data comparing these outcomes with those of current standard-of-care transabdominal ultrasound-guided PC methods. Therefore, researchers conducted a randomized trial comparing specimen quality and financial costs between PC and EUS-guided liver biopsy methods.

Between July 2019 and November 2020, 40 patients were recruited for participation in the study. The researchers found that the PC ultrasound-guided method yielded significantly more optimal specimens, defined as a specimen length of 25 mm or greater and a presence of at least 11 complete portal tracts, compared with the EUS-guided method (57.9% vs 23.8%; P =.028). Additionally, the percutaneous method resulted in worse initial postprocedural pain but was less costly ($1824 vs $3240; P <.001).

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The authors concluded that, “The findings of our present study prove that optimal LB specimens can be procured more reliably and at a lesser cost using the traditional PC method as compared with the EUS-based method.” They added, “until new or novel data are available, the use of EUS must be restricted to the current practice of sampling only suspicious mass lesions in the liver to exclude underlying malignancies or when a diagnosis alone will suffice but without the need for disease grading or staging.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Bang JY, Ward TJ, Guirguis S, et al. Radiology-guided percutaneous approach is superior to EUS for performing liver biopsies. Gut. Published online March 12, 2021. doi: 10.1136/gutjnl-2021-324495

This article originally appeared on Gastroenterology Advisor