Comparative outcomes after EUS-guided vs percutaneous liver biopsy among hospitalized patients in the U.S.: A National Inpatient Sample analysis
Abstract
Background and Aims: Endoscopic ultrasound–guided liver biopsy (EUS-LB) has emerged as an alternative to percutaneous liver biopsy (PLB) for histologic diagnosis, offering advantages such as real-time imaging, access to both hepatic lobes, and the ability to perform concurrent endoscopic evaluation. We conducted this study to compare the outcomes between the two methods.
Methods: We performed a retrospective analysis of the NIS from 2016–2021, identifying adult hospitalizations undergoing liver biopsy using ICD-10 procedure codes. Patients were stratified by approach (EUS-LB vs PLB). Survey-weighted analyses generated national estimates and compared demographics, comorbidities, and hospital characteristics. Propensity score matching (1:1 nearest neighbor) was performed to balance covariates. Primary outcomes included in-hospital mortality, length of stay (LOS), and total hospital charges; secondary outcomes included biopsy-related adverse events.
Results: Among 479,330 inpatient liver biopsy encounters, 156,195 (32.6%) underwent EUS-LB and 323,135 (67.4%) underwent PLB. After propensity matching (n = 13,060), EUS-LB was associated with shorter LOS (6.78 ± 12.8 vs 8.14 ± 11.4 days, p < 0.001), lower in-hospital mortality (1.99% vs 3.17%, p < 0.001), and fewer adverse events including septic shock (1.97% vs 6.09%), mechanical ventilation (1.49% vs 4.46%), and post-procedural hemorrhage (0.42% vs 0.85%) (all p < 0.001). Total hospital charges were slightly higher with EUS-LB ($113,140 vs $103,233, p = 0.008).
Conclusion: EUS-guided liver biopsy was associated with lower mortality, fewer adverse events, and shorter hospital stays compared with PLB, with only marginally higher hospital charges. These findings support EUS-LB as a safe and efficient modality for inpatient liver tissue acquisition.
Methods: We performed a retrospective analysis of the NIS from 2016–2021, identifying adult hospitalizations undergoing liver biopsy using ICD-10 procedure codes. Patients were stratified by approach (EUS-LB vs PLB). Survey-weighted analyses generated national estimates and compared demographics, comorbidities, and hospital characteristics. Propensity score matching (1:1 nearest neighbor) was performed to balance covariates. Primary outcomes included in-hospital mortality, length of stay (LOS), and total hospital charges; secondary outcomes included biopsy-related adverse events.
Results: Among 479,330 inpatient liver biopsy encounters, 156,195 (32.6%) underwent EUS-LB and 323,135 (67.4%) underwent PLB. After propensity matching (n = 13,060), EUS-LB was associated with shorter LOS (6.78 ± 12.8 vs 8.14 ± 11.4 days, p < 0.001), lower in-hospital mortality (1.99% vs 3.17%, p < 0.001), and fewer adverse events including septic shock (1.97% vs 6.09%), mechanical ventilation (1.49% vs 4.46%), and post-procedural hemorrhage (0.42% vs 0.85%) (all p < 0.001). Total hospital charges were slightly higher with EUS-LB ($113,140 vs $103,233, p = 0.008).
Conclusion: EUS-guided liver biopsy was associated with lower mortality, fewer adverse events, and shorter hospital stays compared with PLB, with only marginally higher hospital charges. These findings support EUS-LB as a safe and efficient modality for inpatient liver tissue acquisition.
