Endoscopic ultrasound-guided liver biopsy: Are we ready for routine use?

Endoscopic ultrasound-guided liver biopsy (EUS-LB) is increasingly used for the evaluation of parenchymal liver disease, with recent multicenter data demonstrating high diagnostic yield and a low rate of serious adverse events. While EUS-LB offers technical flexibility through different needle sizes, suction techniques, and limited passes, its overall diagnostic outcomes, including specimen length, portal tract count, and sample adequacy, are comparable to standard percutaneous liver biopsy. Despite these encouraging results, EUS-LB is more invasive, requiring sedation and endoscopic expertise, and is substantially more costly than percutaneous-liver biopsy. Therefore, while EUS-LB is valuable in select clinical scenarios, current evidence does not support its routine use for parenchymal liver disease, and further prospective studies are needed to define its role relative to established percutaneous approaches.