Endoscopic Ultrasound-guided Versus Percutaneous Liver Biopsy in Diagnosing Liver Parenchymal Disease: A Prospective Cohort Study.

BACKGROUND/AIMS: Endoscopic ultrasound-guided liver biopsy (EUS-LB) is an emerging alternative to percutaneous liver biopsy (PC-LB), offering simultaneous assessment of varices and portal pressure and reduced patient discomfort. Prospective data comparing the two are limited. METHODS: In this prospective cohort study at a tertiary center, consecutive patients undergoing EUS-LB with 19G fine-needle biopsy (FNB) needle or PC-LB for parenchymal liver disease were enrolled. Exclusion criteria included grade 2/3 ascites, INR >1.5, platelets <50,000/mm3, inability to stop anticoagulation, and pregnancy. The biopsy technique was decided after discussion with the patient. The primary outcome was sample adequacy, defined as aggregate sample length (ASL) ≥20 mm and ≥11 complete portal triads (CPT). Secondary outcomes included ASL, longest core (LC), CPT count, and adverse events. RESULTS: Of the sixty patients included (EUS-LB n = 30; PC-LB n = 30), platelet counts were higher in those who underwent EUS-LB, while the rest of the blood parameters were similar. Deranged liver enzymes were the predominant indication (EUS-LB 63%, PC-LB 83%). Adequate samples were obtained in 100% of EUS-LB versus 57% of PC-LB cases (P < 0.001). EUS-LB yielded greater ASL (5.4 ± 1.6 cm vs 4.0 ± 1.9 cm; P = 0.002), LC (2.1 ± 0.8 cm vs 1.4 ± 0.6 cm; P = 0.001), and more CPT (median 15 [interquartile range {IQR}: 12.5-18] vs 12 [IQR: 8.2-16]; P = 0.01). Immediate postprocedure pain scores were lower with EUS-LB (median 1 [0-2] vs 4 [4-6]; P < 0.001). No major complications occurred; puncture-site bleed occurred in 2 (6.6%) EUS-LB patients and was controlled endoscopically. CONCLUSION: EUS-LB is a feasible alternative to PC-LB with a comparable diagnostic yield, less immediate postprocedure discomfort, and a comparable safety profile.