EUS-Guided Liver Biopsy and Portal Pressure Measurement Compared With a Transjugular Approach: A Systematic Review and Random Effect Meta-analysis.

BACKGROUND AND AIMS: The transjugular (TJ) approach has traditionally been used to assess the severity of sinusoidal portal hypertension and obtain a liver biopsy (LB). According to evidence, approximately 25-35% of TJ-LBs satisfy the adequacy quality criteria set by the American Association for the Study of Liver Diseases (AASLD). Endoscopic ultrasound (EUS) is a novel technology that allows for simultaneous portal pressure, liver biopsy, and variceal screening assessment. This study aims to compare outcomes of EUS versus the TJ approach. METHODOLOGY: A comprehensive search of PubMed, Cochrane, and Embase, with eight studies included in the final analysis. The primary outcome was correlation between hepatic venous pressure gradient (HVPG) and portal pressure gradient (PPG), with secondary outcomes of LB adequacy and technical success. A systematic review and meta-analysis were performed to generate a pooled synthesis of outcomes. RESULTS: A total of eight studies with 663 patients were included. EUS-PPG exhibited a strong pooled correlation with HVPG (r = 0.81), demonstrating a close correlation between pressure measurements. Technical success rates were similar for EUS and TJ approaches (97.4% vs 97.3%). Biopsy-related outcomes such as portal triad count (MD = 6.28), total specimen length (MD = 30.01 mm), and longest core length (MD = 5.60 mm) demonstrated a numerical difference that did not achieve statistical significance. CONCLUSION: The measurement of EUS-PPG exhibited excellent physiologic correlation with HVPG and similar technical success. Outcomes related to the biopsy had numerical differences that were not statistically significant and should be considered hypothesis-generating, given considerable heterogeneity.