Endoscopic ultrasound–guided liver biopsy (EUS-LB) isincreasingly used as an alternative to percutaneous liver biopsy (PC-LB), butcomparative evidence on optimal needle selection remains limited. This studycompared diagnostic yield and tissue adequacy of EUS and percutaneous biopsy needles using explanted cirrhotic livers.

In this prospective, comparative ex-vivo study, 30 adult explanted cirrhotic livers underwent biopsies using four needles: PC-16G, PC-18G, EUS-19G FNB, and EUS-22G FNB from both lobes (total 240 biopsies). Tissueadequacy was defined as specimen length >15 mm and ≥11 complete portaltracts (CPT). Histopathology was assessed by a blinded pathologist. Repeated-measures ANOVA, Cochran’s Q, and McNemar tests were used.

Mean total specimen length was highest with EUS-19G (26.8 ± 14.9mm), followed by PC-16G (18.8 ± 5.5 mm), PC-18G (17.9 ± 6.2 mm), and EUS-22G (12.9 ± 8.2 mm) (p<0.001). Mean CPT was comparable between EUS-19G(13.5 ± 3.8) and PC-16G (13.4 ± 2.8), but significantly lower with EUS-22G (8.9 ±3.2, p<0.001). Tissue adequacy was achieved in 98% with PC-16G, 93% with PC-18G, 92% with EUS-19G, and 50% with EUS-22G (p<0.001). Cirrhosis was most accurately identified with PC-16G and EUS-19G, while EUS-22G had higher non-diagnostic rates and lower fibrosis staging accuracy.

EUS-19G provides tissue adequacy and portal tract yieldcomparable to standard percutaneous biopsy needles and yields significantlylonger core specimens. EUS-22G is inferior for diagnostic liver biopsy. EUS-19Grepresents a reliable alternative to PC-LB in appropriately selected patients.