Diagnostic performance and safety of EUS-guided liver biopsy: A multicenter Latin American comparative study

Abstract

Liver biopsy is the gold standard for diagnosing hepatic disease. Although percutaneous liver biopsy (PLB) is the conventional procedure for acquiring liver tissue, it has limitations. EUS-guided liver biopsy (EUS-LB) represents an emerging alternative. This study primarily compared the diagnostic adequacy and safety of EUS-LB and PLB. Secondarily, compared histological quality and safety between Franseen (EUS-FT) and 3-prong asymmetrical tip (EUS-TPT) needles in EUS-LB. We conducted a multicenter, observational study from August 2023 to December 2025, comparing EUS-LB and PLB. Primary outcome was diagnostic sample adequacy according to American Association for the Study of Liver Diseases (AASLD) criteria (≥11 complete portal triads [CPTs] and ≥20 mm length). Secondary outcomes included CPTs, sample length, and 30-day adverse events. EUS-LB outcomes were further compared between EUS-FT and EUS-TPT fine-needle biopsy needles. A total of 211 patients were included, comprising 89 EUS-LB and 122 PLB. EUS-LB demonstrated superior sample adequacy (80.9% vs. 22.1%, P < 0.001), greater tissue yield (mean CPT 23.0 vs. 14.3, P < 0.001), and fewer adverse events (0.0% vs. 6.6%, P = 0.02) compared with PLB. Among EUS-LB cases, the EUS-FT needle provided longer tissue cores (54.4 mm vs. 18.5 mm; P < 0.001), while the EUS-TPT needle yielded more CPT (29.6 vs. 16.6; P < 0.001). Safety outcomes were comparable between needles within the EUS-LB group. EUS-LB was associated with higher diagnostic adequacy and lower rate of adverse events compared with PLB. Both EUS-FT and EUS-TPT needles are effective and safe for EUS-LB.