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

Eyad Gadour; Abeer Awad; Zeinab Hassan; Khalid Jebril Shrwani; Bogdan Miutescu; Hussein Hassan Okasha

doi:10.3748/wjg.v30.i7.742

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

World J Gastroenterol. 2024 Feb 21;30(7):742-758. doi: 10.3748/wjg.v30.i7.742.

Authors

Eyad Gadour^{1

2}, Abeer Awad³, Zeinab Hassan⁴, Khalid Jebril Shrwani^{5

6}, Bogdan Miutescu^{7

8}, Hussein Hassan Okasha⁹

Affiliations

¹ Department of Gastroenterology and Hepatology, King Abdulaziz Hospital-National Guard, Ahsa 31982, Saudi Arabia.
² Department of Internal Medicine, Faculty of Medicine, Zamzam University College, Khartoum 11113, Sudan. eyadgadour@doctors.org.uk.
³ Department of Hepatogastroenterology, Kasar Alainy Hospital, Faculty of Medicine, Cairo University, Cairo 11451, Egypt.
⁴ Department of Internal Medicine, Stockport Hospitals NHS Foundation Trust, Manchester SK2 7JE, United Kingdom.
⁵ Public Health Authority, Saudi Center for Disease Prevention and Control, Jazan 45142, Saudi Arabia.
⁶ Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, School of Medicine and Life Sciences, University of Liverpool, Liverpool, United Kingdom.
⁷ Department of Gastroenterology and Hepatology, Victor Babes University of Medicine and Pharmacy, Timisoara 300041, Romania.
⁸ Advanced Regional Research Center in Gastroenterology and Hepatology, Victor Babes University of Medicine and Pharmacy, Timisoara 30041, Romania.
⁹ Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Cairo University, Cairo 11562, Egypt.

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.

Keywords: Endoscopic ultrasound; Fine needle aspiration; Focal liver lesion; Gastric varices; Liver abscess drainage.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Digestive System Diseases*
Endoscopic Ultrasound-Guided Fine Needle Aspiration / methods
Endosonography / methods
Humans
Liver Abscess*