cancers Article Diagnostic Yield of Endoscopic Ultrasound-Guided Liver Biopsy in Comparison to Percutaneous Liver Biopsy: A Two-Center Experience Antonio Facciorusso 1 , Daryl Ramai 2 , Maria Cristina Conti Bellocchi 3 , Laura Bernardoni 3 , Erminia Manfrin 4 , Nicola Muscatiello 1 and Stefano Francesco Crinò 3, *   Citation: Facciorusso, A.; Ramai, D.; Conti Bellocchi, M.C.; Bernardoni, L.; Manfrin, E.; Muscatiello, N.; Crinò, S.F. Diagnostic Yield of Endoscopic Ultrasound-Guided Liver Biopsy in Comparison to Percutaneous Liver Biopsy: A Two-Center Experience. Cancers 2021, 13, 3062. https:// doi.org/10.3390/cancers13123062 Academic Editor: Masaru Miyazaki Received: 3 May 2021 Accepted: 16 June 2021 Published: 19 June 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). 1 Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; antonio.facciorusso@virgilio.it (A.F.); nicomuscatiello@gmail.com (N.M.) 2 Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, New York, NY 11201, USA; dramai@tbh.org 3 Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, 37134 Verona, Italy; mariacristina.contibellocchi@aovr.veneto.it (M.C.C.B.); laura.bernardoni@aovr.veneto.it (L.B.) 4 Department of Diagnostics and Public Health, G.B. Rossi University Hospital, 37134 Verona, Italy; erminia.manfrin@univr.it * Correspondence: stefanofrancesco.crino@aovr.veneto.it Simple Summary: Traditionally, liver biopsy has been performed by percutaneous radiology-guided methods. Advances in endoscopic ultrasound have demonstrated the efficacy of endoscopic based techniques for liver biopsy. Studies comparing both methods are scarce and have conflicting results. Our study compares percutaneous and endoscopic ultrasound methods for liver biopsy. Our analysis shows no evidence to support the wide use of endoscopic ultrasound. Percutaneous liver biopsy remains the sampling method of choice in this field. Abstract: There is scarce and conflicting evidence on the comparison between endoscopic ultrasound (EUS) and percutaneous (PC)-guided liver biopsy (LB). The aim of this study was to compare the two approaches in a series of patients with parenchymal and focal liver lesions. Fifty-four patients undergoing EUS-LB in two high-volume centers between 2017 and 2021 were compared to 62 patients who underwent PC-LB. The primary outcome was diagnostic adequacy rate. The secondary outcomes were diagnostic accuracy, total sample length (TSL), number of complete portal tracts (CPTs), procedural duration, and adverse events. Variables were compared using the Chi-square and Mann–Whitney test. Median age was 56 years (interquartile range 48–69) in the EUS-LB group and 54 years (45–67) in the PC-LB group with most patients being male. Indication for LB was due to parenchymal disease in 50% of patients, whereas the other patients underwent LB due to focal liver lesions. Diagnostic adequacy was 100% in PC-LB and 94.4% in the EUS-LB group (p = 0.74), whereas diagnostic accuracy was 88.8% in the EUS-LB group and 100% in the PC-LB group (p = 0.82). Median TSL was significantly greater in the PC-LB group (27.4 mm, IQR 21–29) when compared to the EUS-LB group (18.5 mm, 10.1–22.4; p = 0.02). The number of complete portal tracts was 21 (11–24) in the PC-LB group and 18.5 (10–23.2) in EUS-LB group (p = 0.09). EUS-LB was a significantly longer procedure (7 min, 5–11 versus 1 min, 1–3 of PC-LB; p < 0.001) and no evidence of adverse events was observed in any of the study groups. These results were confirmed in the subgroup analysis performed according to an indication for LB (parenchymal disease versus focal lesion). Although PC-LB yielded specimens with greater TSL, diagnostic adequacy and accuracy were similar between the two procedures. Keywords: endoscopic ultrasound; liver biopsy; percutaneous liver biopsy Cancers 2021, 13, 3062. https://doi.org/10.3390/cancers13123062 https://www.mdpi.com/journal/cancers