EUS-guided liver biopsy: A useful and cost-effective alternative for specific indications in the study of liver diseases.

Background and Objectives: Comparative studies have demonstrated that EUS-guided liver biopsy (EUS-LB) is a useful and safe technique. However, there is not sufficient evidence information on their cost differences and potential applications. We aimed to investigate whether EUS-LB is a cost-effective alternative to traditional LB methods (percutaneous [PC-LB], transjugular [TJ-LB]) and determine its indications in clinical practice. Methods: In this observational, prospective, and multicenter study, patients who underwent EUS-LB at different tertiary centers (N = 52) were compared with a similar number of PC-LB (N = 50) and TJ-LB (N = 37) collected retrospectively. Diagnostic yield (percentage of conclusive histological diagnosis), specimen quality, adverse events, and cost-effectiveness were analyzed. Results: EUS-LB had 87% of diagnostic yield and 4% of mild adverse events, similar to traditional techniques (P = 0.097 and P = 0.252, respectively). Despite higher tissue fragmentation and lower longest specimen length in EUS-LB, no differences were found in the number of complete portal tracts, tissue adequacy (EUS-LB, 19%; PC-LB, 30%; TJ-LB, 36%; P = 0.164) or pathologist satisfaction, allowing adequate fibrosis stage assessment, particularly in metabolic dysfunction-associated steatotic liver disease. EUS-LB was more cost-effective when both LB and EUS were indicated (saving: €112.20 × 15% additional histological diagnosis [AHD]); in patients with cholestasis unsuitable for magnetic resonance cholangiopancreatography (MRCP) prior to LB; contraindication for the PC-LB, including cases of uncooperative individuals (saving: €234.75 × 15% AHD). Conclusions: EUS-LB is a useful alternative to traditional methods and the most cost-effective option when both LB and EUS are indicated, in cases of cholestasis as an alternative to MRCP and when the PC route is contraindicated.