Background and Aims

EUS-guided liver biopsy (LB) is an emerging technique over conventional percutaneous (PC) or transjugular (TJ) approaches. Recent studies have reported that EUS-guided LB may have a better safety profile than PC LB or TJ LB without compromising diagnostic yield, and the outcomes are varied with respect to the types of biopsy needles. We performed a systematic review and meta-analysis to estimate the diagnostic yield, specimen adequacy, and adverse events associated with EUS-guided LB.

Methods

We conducted a comprehensive search of multiple electronic databases and conference proceedings, including PubMed, EMBASE, and Web of Science databases (from inception to June 2018) to identify studies that reported on EUS-guided LB. The primary outcome was to estimate the pooled rates of successful diagnosis made and insufficient specimen obtained. The secondary outcome was to estimate the pooled rate of adverse events. A subgroup analysis compared the outcomes based on the type of biopsy needle.

Results

A total of 9 study arms with 437 patients were included. The pooled rate of successful histologic diagnoses was 93.9% (95% confidence interval [CI], 84.9-97.7), with heterogeneity I² of 75.3%. The pooled rate of insufficient specimen obtained was 10.1% (95% CI, 3.5-25.8), with I² = 71.6%. The pooled rate of adverse events with EUS-guided LB was 2.3% (95% CI; 1.1-4.8, I² = 0). On subgroup analysis, the adverse events rate with a 19-gauge FNA needle (vs other core biopsy needles) was 0.9% (vs 2.7%, P = .28), and the rate of diagnostic yield was 95.8% (vs 92.7%, P = .59). The rate of insufficient specimen was significantly lower with an FNA needle compared with the core needle (4% vs 20%, P = .03).

Conclusion

With a histologic diagnosis rate of 93.9% and adverse event rate of 2.3%, EUS-guided LB appears to be both effective and safe. A 19-gauge FNA needle provides significantly better biopsy specimens and seems to have better outcomes compared with other core biopsy needles.

中文翻译：

---

EUS指导的肝活检的有效性和安全性：系统评价和荟萃分析

背景和目标

EUS引导的肝活检（LB）是超越常规经皮（PC）或经颈静脉（TJ）方法的新兴技术。最近的研究报道，EUS引导的LB可能比PC LB或TJ LB具有更好的安全性，而又不影响诊断率，并且其结果因活检针的类型而异。我们进行了系统的综述和荟萃分析，以评估诊断性结局，标本充分性以及与EUS指导的LB相关的不良事件。

方法

我们对多个电子数据库和会议记录进行了全面搜索，包括PubMed，EMBASE和Web of Science数据库（从成立到2018年6月），以识别以EUS指导的LB报告的研究。主要结果是估计成功诊断和未获得足够标本的合并率。次要结果是估计不良事件的合并率。亚组分析根据活检针的类型比较了结局。

结果

总共包括9个研究组，共437名患者。成功的组织学诊断合并率为93.9％（95％置信区间[CI]，84.9-97.7），异质性I ²为75.3％。获得的不足样本的合并率为10.1％（95％CI，3.5-25.8），I ²  = 71.6％。以EUS指导的LB不良事件合并率为2.3％（95％CI; 1.1-4.8，I ²  = 0）。在亚组分析中，使用19号FNA针（相对于其他核心活检针）的不良事件发生率为0.9％（相对于2.7％，P  = 0.28），诊断结果的发生率为95.8％（相对于92.7％，P  = .59）。与芯针相比，FNA针的标本不足率显着降低（P分别为4％和20％，P = .03）。

结论

EUS引导的LB组织学诊断率为93.9％，不良事件率为2.3％，似乎既有效又安全。与其他核心活检针相比，使用19号FNA针可以提供更好的活检标本，并且似乎具有更好的结果。