Diagnostic Yield of Endoscopic Ultrasound-Guided Liver Biopsy in Comparison to Percutaneous Liver Biopsy: A Meta-Analysis of Randomized Controlled Trials and Trial Sequential Analysis
Megha Bhandari,
Jayanta Samanta,
Marco Spadaccini,
Alessandro Fugazza,
Stefano Francesco Crinò,
Paraskevas Gkolfakis,
Konstantinos Triantafyllou,
Jahnvi Dhar,
Marcello Maida,
Nicola Pugliese,
Cesare Hassan,
Alessandro Repici,
Alessio Aghemo,
Gaetano Serviddio,
Antonio Facciorusso
Affiliations
Megha Bhandari
Hepatology Department, Cambridge University Hospital, Cambridge CB4 1GN, UK
Jayanta Samanta
Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
Marco Spadaccini
Endoscopy Unit, Department of Biomedical Sciences, Humanitas University, Humanitas Clinical and Research Center IRCCS, Rozzano, 20089 Milan, Italy
Alessandro Fugazza
Endoscopy Unit, Department of Biomedical Sciences, Humanitas University, Humanitas Clinical and Research Center IRCCS, Rozzano, 20089 Milan, Italy
Stefano Francesco Crinò
Diagnostic and Interventional Endoscopy of Pancreas, Pancreas Institute, University of Verona, 37134 Verona, Italy
Paraskevas Gkolfakis
Department of Gastroenterology, General Hospital of Nea Ionia “Konstantopoulio-Patision”, 142 33 Athens, Greece
Konstantinos Triantafyllou
Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 124 62 Athens, Greece
Jahnvi Dhar
Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
Marcello Maida
Faculty of Medicine, “Kore” University of Enna, 94100 Enna, Italy
Nicola Pugliese
Endoscopy Unit, Department of Biomedical Sciences, Humanitas University, Humanitas Clinical and Research Center IRCCS, Rozzano, 20089 Milan, Italy
Cesare Hassan
Endoscopy Unit, Department of Biomedical Sciences, Humanitas University, Humanitas Clinical and Research Center IRCCS, Rozzano, 20089 Milan, Italy
Alessandro Repici
Endoscopy Unit, Department of Biomedical Sciences, Humanitas University, Humanitas Clinical and Research Center IRCCS, Rozzano, 20089 Milan, Italy
Alessio Aghemo
Endoscopy Unit, Department of Biomedical Sciences, Humanitas University, Humanitas Clinical and Research Center IRCCS, Rozzano, 20089 Milan, Italy
Gaetano Serviddio
Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Via L Pinto 1, 71122 Foggia, Italy
Antonio Facciorusso
Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Via L Pinto 1, 71122 Foggia, Italy
Background: The efficacy of endoscopic ultrasound-guided liver biopsy (EUS-LB) compared to percutaneous liver biopsy (PC-LB) remains uncertain. Methods: Our data consist of randomized controlled trials (RCTs) comparing EUS-LB to PC-LB, found through a literature search via PubMed/Medline and Embase. The primary outcome was sample adequacy, whereas secondary outcomes were longest and total lengths of tissue specimens, diagnostic accuracy, and number of complete portal tracts (CPTs). Results: Sample adequacy did not significantly differ between EUS-LB and PC-LB (risk ratio [RR] 1.18; 95% confidence interval [CI] 0.58–2.38; p = 0.65), with very low evidence quality and inadequate sample size as per trial sequential analysis (TSA). The two techniques were equivalent with respect to diagnostic accuracy (RR: 1; CI: 0.95–1.05; p = 0.88), mean number of complete portal tracts (mean difference: 2.29, −4.08 to 8.66; p = 0.48), and total specimen length (mean difference: −0.51, −20.92 to 19.9; p = 0.96). The mean maximum specimen length was significantly longer in the PC-LB group (mean difference: −3.11, −5.51 to −0.71; p = 0.01), and TSA showed that the required information size was reached. Conclusion: EUS-LB and PC-LB are comparable in terms of diagnostic performance although PC-LB provides longer non-fragmented specimens.
