Endoscopic ultrasound-guided liver biopsy: down but not out

The paper by Bang et al 1 is a much-needed randomised study, which concluded that conventional ultrasound-guided percutaneous liver biopsy was superior to the relatively new endoscopic ultrasound (EUS)-guided approach. We wish to share two recent cases where EUS-guided liver biopsy safely and effectively provided a definitive diagnosis, and debate the conclusions raised by the authors. In the first case, a 55-year-old woman with lupus was referred with transaminitis, mild IgG elevation and ultrasound evidence of splenomegaly and unexplained dilatation of the common bile duct (16 mm) confirmed on MRI. Elastography revealed elevated liver stiffness of 21 kPa. In a single visit, she underwent gastroscopy for variceal screening, EUS-guided assessment for ductal dilatation and EUS-guided liver biopsy. An adequate sample was obtained and a diagnosis of moderate …