Endoscopic ultrasound-guided liver biopsy and portal pressure measurement compared with a transjugular approach: a...

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% to 35% of TJ-LBs satisfy the adequacy quality criteria set by the American Association for the Study of Liver Diseases. EUS is a novel technology that allows for simultaneous portal pressure, LB, and variceal screening assessment. This study aims to compare the outcomes of EUS versus the TJ approach.

A comprehensive search of PubMed, Cochrane, and Embase was performed, with 8 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 was performed to provide a pooled synthesis of the outcomes.

A total of 8 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 (mean difference [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.

The measurement of EUS-PPG exhibited excellent physiological 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.