Diagnostic and therapeutic role of endoscopic ultrasound in liver diseases: A systematic review and meta-analysis

Abstract

BACKGROUND In hepatology, the clinical use of endoscopic ultrasound (EUS) has experienced a notable increase in recent times. These applications range from the diagnosis to the treatment of various liver diseases. Therefore, this systematic review summarizes the evidence for the diagnostic and therapeutic roles of EUS in liver diseases. AIM To examine and summarize the current available evidence of the possible roles of the EUS in making a suitable diagnosis in liver diseases as well as the therapeutic accuracy and efficacy. METHODS PubMed, Medline, Cochrane Library, Web of Science, and Google Scholar databases were extensively searched until October 2023. The methodological quality of the eligible articles was assessed using the Newcastle-Ottawa scale or Cochrane Risk of Bias tool. In addition, statistical analyses were performed using the Comprehensive Meta-Analysis software. RESULTS Overall, 45 articles on EUS were included (28 on diagnostic role and 17 on therapeutic role). Pooled analysis demonstrated that EUS diagnostic tests had an accuracy of 92.4% for focal liver lesions (FLL) and 96.6% for parenchymal liver diseases. EUS-guided liver biopsies with either fine needle aspiration or fine needle biopsy had low complication rates when sampling FLL and parenchymal liver diseases (3.1% and 8.7%, respectively). Analysis of data from four studies showed that EUS-guided liver abscess had high clinical (90.7%) and technical success (90.7%) without significant complications. Similarly, EUS-guided interventions for the treatment of gastric varices (GV) have high technical success (98%) and GV obliteration rate (84%) with few complications (15%) and rebleeding events (17%). CONCLUSION EUS in liver diseases is a promising technique with the potential to be considered a first-line therapeutic and diagnostic option in selected cases.

Is endoscopic ultrasound a promising technique in the diagnosis and treatment of liver diseases?

“…Upon reading the article by Gadour et al [ 1 ], a comment emerged. The article thoroughly reviews and summarizes the current evidence on the roles of endoscopic ultrasound (EUS) in accurately diagnosing liver disease as well as its therapeutic accuracy and efficacy[ 1 ].…”

“…Upon reading the article by Gadour et al [ 1 ], a comment emerged. The article thoroughly reviews and summarizes the current evidence on the roles of endoscopic ultrasound (EUS) in accurately diagnosing liver disease as well as its therapeutic accuracy and efficacy[ 1 ]. They concluded that EUS is a promising technique with potential to be a first-line option for diagnosis and treatment in a subset of liver diseases.…”

“…They concluded that EUS is a promising technique with potential to be a first-line option for diagnosis and treatment in a subset of liver diseases. This comprehensive review effectively highlights EUS as a safe and effective method in various interventions performed for the diagnosis and/or treatment of liver diseases[ 1 ].…”

“…However, direct comparisons between EUS and percutaneous US in the diagnosis and treatment of liver disease are scarce[ 2 - 4 ], and, according to our best knowledge, the only randomized clinical trial directly comparing the two techniques demonstrates the advantage of percutaneous US[ 5 ]. Albeit we recognize the robust design and execution, this study[ 1 ], also, primarily encompasses retrospective and prospective.…”

Practical approach to linear endoscopic ultrasound examination of the gallbladder

“…Conversely, linear EUS offers a localized oblique image parallel to the scope and allows therapeutic intervention under ultrasound[ 2 ]. While radial EUS was the first to be developed, linear EUS has gained popularity over the years due to its ability to add other diagnostic tools such as the fine-needle aspiration (FNA)[ 3 ]. This current review discusses the role of linear EUS in gallbladder (GB) imaging and its clinical implications.…”