Background and Objectives: Liver biopsy is the gold standard for diagnosing hepatic disease. Although percutaneous liver biopsy (PLB) is the conventional procedure for acquiring liver tissue, it has limitations. EUS-guided liver biopsy (EUS-LB) represents an emerging alternative. This study primarily compared the diagnostic adequacy and safety of EUS-LB and PLB. Secondarily, compared histological quality and safety between Franseen (EUS-FT) and 3-prong asymmetrical tip (EUS-TPT) needles in EUS-LB. Methods: We conducted a multicenter, observational study from August 2023 to December 2025, comparing EUS-LB and PLB. Primary outcome was diagnostic sample adequacy according to American Association for the Study of Liver Diseases (AASLD) criteria (≥11 complete portal triads [CPTs] and ≥20 mm length). Secondary outcomes included CPTs, sample length, and 30-day adverse events. EUS-LB outcomes were further compared between EUS-FT and EUS-TPT fine-needle biopsy needles. Results: A total of 211 patients were included, comprising 89 EUS-LB and 122 PLB. EUS-LB demonstrated superior sample adequacy (80.9% vs. 22.1%, P < 0.001), greater tissue yield (mean CPT 23.0 vs. 14.3, P < 0.001), and fewer adverse events (0.0% vs. 6.6%, P = 0.02) compared with PLB. Among EUS-LB cases, the EUS-FT needle provided longer tissue cores (54.4 mm vs. 18.5 mm; P < 0.001), while the EUS-TPT needle yielded more CPT (29.6 vs. 16.6; P < 0.001). Safety outcomes were comparable between needles within the EUS-LB group. Conclusions: EUS-LB was associated with higher diagnostic adequacy and lower rate of adverse events compared with PLB. Both EUS-FT and EUS-TPT needles are effective and safe for EUS-LB.
Background and Objectives: Noninvasive diagnostics have become an integral part of the evaluation of patients with chronic liver diseases. Ultrasound-based elastography estimates the degree of fibrosis within the liver by measuring the speed through which shear waves, generated from a push-pulse, propagate through the liver. Ultrasound can also be used to estimate the degree of hepatic steatosis by measuring the attenuation of sound waves through the liver. Ultrasound-based elastography and attenuation typically use a transabdominal probe, though recent developments allow for both two-dimensional shear wave elastography (2D-SWE) and attenuation imaging (ATI) through a curvilinear echoendoscope. The aim of this study was to define the optimal technique for 2D EUS-SWE ATI and to compare performance with currently available modalities. Methods: A curvilinear echoendoscope was used to test the accuracy of measurements compared with a hydrogel reference model for different regions of interest depth, size, placement method, and number of measurements. These measurements were then repeated by 5 expert endosonographers using surgically implanted reference models in porcine liver. Statistical analysis was performed using R (version 4.4.1, R Core Team 2021, Vienna, Austria). Results: Optimal settings for region of interest size, depth, placement, and number were identified. Accuracy (defined by % deviation from reference) of SWE was highest for 2D-SWE compared with conventional modalities, while accuracy of the novel platform’s ATI was similar to the controlled attenuation parameter. There was excellent interobserver agreement using the novel platform with optimal technique (intraclass correlation coefficient of 0.999 [ P < 0.001]). Conclusions: Our study serves as the basis for obtaining measurements with optimal accuracy using a novel EUS-based platform combining 2D-SWE and ATI. In this preclinical model, the novel platform demonstrated excellent accuracy across a broad range of reference models, with excellent interobserver agreement, and was more accurate than conventional modalities using point SWE.
Background and Objectives: Distinguishing pancreatic cancer from inflammatory conditions in patients with chronic pancreatitis (CP) is challenging. Contrast-enhanced magnetic resonance imaging (MRI) and EUS are key diagnostic modalities, but their optimal use (alone or in combination) for accurate diagnosis remains unclear. This study aimed to compare the diagnostic efficacy of EUS and contrast-enhanced MRI for focal pancreatic lesions in CP patients. Methods: This single-center retrospective study enrolled CP patients with indeterminate focal pancreatic lesions detected by contrast-enhanced computed tomography. Patients underwent contrast-enhanced MRI, EUS, or both, and were categorized into 3 groups: MRI group, EUS group, and Combination group. Primary diagnoses were based on the reports of imaging or EUS-guided tissue acquisition, while final diagnoses were confirmed by surgical pathology or follow-up. The primary outcome was diagnostic performance. Results: A total of 103 patients were enrolled: 48 in the MRI group, 10 in the EUS group, and 45 in the Combination group. There were no statistically significant differences in diagnostic performance between these 2 independent groups. However, in the paired subgroup analysis, EUS demonstrated significantly higher accuracy than MRI (84.4% vs. 68.9%, P = 0.039). Further comparison revealed no significant difference in sensitivity (50.0% vs. 64.3%, P = 0.500), specificity (100.0% vs. 83.9%, P = 0.063), and accuracy (84.4% vs. 77.8%, P = 0.453) between EUS and the combination diagnosis. Conclusion: EUS was a superior individual diagnostic modality to MRI for evaluating focal pancreatic lesions in CP patients, and MRI did not provide significant additional diagnostic benefit over EUS alone.
