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

This is the authors' abstract. We don't add key points for this paper.

Background and Objectives: 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. Methods: 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. Results: 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. Conclusions: 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.