Although liver biopsies (LBs) are being increasingly performed under endoscopic ultrasound (EUS) guidance, there are limited data comparing outcomes with current standard-of-care, transabdominal ultrasound (US)-guided percutaneous (PC) methods. In a randomised trial, we observed that the PC, US-guided method yielded significantly more optimal specimens, defined as specimen length of 25 mm or greater and presence of at least 11 complete portal tracts, compared with the EUS-guided method (57.9% vs 23.8%, p=0.028). Also, the PC method resulted in worse initial postprocedural pain but was less costly (US$1824 vs US$3240, p<0.001). Despite significant advances in non-invasive assessment, LB still remains the gold standard for evaluation of subacute and chronic liver diseases, whose clinical presentation can oftentimes be both confusing and challenging.1 LB is usually performed percutaneously under the guidance of real-time imaging using transabdominal US or CT, or via the transjugular approach in patients with underlying coagulopathy. More recently, endoscopists have been performing the procedure via the transgastric or transduodenal route under EUS guidance. Perceived advantages include the ability to simultaneously exclude diseases in the pancreas or bile duct, access to both the left and right lobes of the liver, and avoidance of intraprocedural pain as EUS is performed under sedation.2 While prospective single-arm and retrospective comparative studies suggest that EUS-guided LB can establish the diagnosis in more than 90% of patients and is equally successful,3 4 there are no randomised trials comparing outcomes with PC methods. Additionally, in the present era of cost containment, financial analysis is critical in healthcare decision-making, particularly for commonly indicated procedures such as LB. Therefore, we conducted a randomised trial comparing specimen quality and financial costs between PC and EUS-guided LB methods. Eligible consecutive patients from outpatient clinics or inpatient wards were referred by hepatologists to undergo LB and were randomised to either EUS-guided …

中文翻译：

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放射学引导的经皮方法优于 EUS 进行肝活检

尽管肝活检 (LBs) 越来越多地在内镜超声 (EUS) 指导下进行，但将结果与目前的标准护理、经腹超声 (US) 引导的经皮 (PC) 方法进行比较的数据有限。在一项随机试验中，我们观察到，与 EUS 引导的方法相比，PC、US 引导的方法产生了明显更好的标本，定义为标本长度为 25 毫米或更长，并且存在至少 11 个完整的门静脉束（57.9%与 23.8%，p=0.028）。此外，PC 方法导致最初的术后疼痛更严重，但成本更低（1824 美元对 3240 美元，p<0.001）。尽管在无创评估方面取得了重大进展，但 LB 仍然是评估亚急性和慢性肝病的金标准，其临床表现往往既令人困惑又具有挑战性。1 LB 通常在使用经腹超声或 CT 实时成像的指导下经皮进行，或通过经颈静脉途径在潜在凝血病患者中进行。最近，内镜医师一直在 EUS 指导下通过经胃或经十二指肠途径进行手术。公认的优势包括能够同时排除胰腺或胆管疾病，进入肝脏左右叶，以及在镇静下进行 EUS 时避免术中疼痛。 2 虽然前瞻性单臂和回顾性比较研究表明 EUS 引导的 LB 可以在超过 90% 的患者中建立诊断并且同样成功，3 4 没有随机试验将结果与 PC 方法进行比较。此外，在当前成本控制的时代，财务分析在医疗保健决策中至关重要，特别是对于常见的指示程序，如 LB。因此，我们进行了一项随机试验，比较了 PC 和 EUS 引导的 LB 方法之间的标本质量和财务成本。来自门诊诊所或住院病房的合格连续患者由肝病学家转介接受 LB，并被随机分配到 EUS 引导下的任一…