Systematic Reviews
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2024; 30(7): 742-758
Published online Feb 21, 2024. doi: 10.3748/wjg.v30.i7.742
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
Eyad Gadour, Department of Gastroenterology and Hepatology, King Abdulaziz Hospital-National Guard, Ahsa 31982, Saudi Arabia
Eyad Gadour, Department of Internal Medicine, Faculty of Medicine, Zamzam University College, Khartoum 11113, Sudan
Abeer Awad, Department of Hepatogastroenterology, Kasar Alainy Hospital, Faculty of Medicine, Cairo University, Cairo 11451, Egypt
Zeinab Hassan, Department of Internal Medicine, Stockport Hospitals NHS Foundation Trust, Manchester SK2 7JE, United Kingdom
Khalid Jebril Shrwani, Public Health Authority, Saudi Center for Disease Prevention and Control, Jazan 45142, Saudi Arabia
Khalid Jebril Shrwani, 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
Bogdan Miutescu, Department of Gastroenterology and Hepatology, Victor Babes University of Medicine and Pharmacy, Timisoara 300041, Romania
Bogdan Miutescu, Advanced Regional Research Center in Gastroenterology and Hepatology, Victor Babes University of Medicine and Pharmacy, Timisoara 30041, Romania
Hussein Hassan Okasha, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Cairo University, Cairo 11562, Egypt
Author contributions: Gadour E, and Okasha HH contributed to conceptualization; Gadour E, Awad A, Miutescu B and Okasha HH contributed to methodology; Hassan Z contributed to software; Okasha HH, Miutescu B and Gadour E contributed to validation; Gadour E contributed to formal analysis; Hassan Z, Shrwani KJ and Gadour E contributed to investigation; Awad A contributed to resources; Awad A and Okasha HH contributed to data curation; Awad A contributed to writing—original draft preparation; Gadour E, Okasha HH, Hassan Z, Awad A, Miutescu B and Shrwani KJ contributed to writing—review and editing; Hassan Z contributed to visualization; Okasha HH, and Gadour E contributed to supervision; Gadour E contributed to project administration; All authors have read and agreed to the published version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Eyad Gadour, CCST, FRCP, MBBS, MRCP, Associate Professor, Consultant Physician-Scientist, Department of Gastroenterology and Hepatology, King Abdulaziz Hospital-National Guard, King Abdullah Military City, Al Mubarraz, Ahsa 31982, Saudi Arabia. eyadgadour@doctors.org.uk
Received: November 12, 2023
Peer-review started: November 13, 2023
First decision: December 7, 2023
Revised: December 19, 2023
Accepted: January 16, 2024
Article in press: January 16, 2024
Published online: February 21, 2024
Processing time: 100 Days and 24 Hours
ARTICLE HIGHLIGHTS
Research background

Endoscopic ultrasound (EUS) is a diagnostic and therapeutic procedure. The use of the EUS in the field of liver disease is recognizably increasing. However, the safety and efficacy are not well addressed.

Research motivation

We aimed to explore the safety and accuracy profile of the EUS in hepatology by comparing 28 articles evaluating the diagnostic role and 17 evaluating the therapeutic role of EUS.

Research objectives

To examine and explore the accuracy and efficacy of the role of the EUS in liver disease including the international aspects.

Research methods

We independently conducted an extensive systematic review using an electronic search on PubMed, Medline, Cochrane Library, Web of Science, and Google Scholar databases were extensively scoured for studies until October 2023. The methodological quality of the eligible articles was performed using the Newcastle-Ottawa scale or Cochrane’s Risk of Bias tool. In addition, statistical analyses were performed with the comprehensive meta-analysis software.

Research results

The pooled analysis demonstrated that EUS diagnostic tests have an accuracy of 92.4% for focal liver lesions (FLL) and 96.6% for parenchymal liver diseases. In addition, the cumulative analyses showed that EUS-guided liver biopsies with either fine needle aspiration or fine needle biopsy have low complication rates when sampling FLL and parenchymal liver diseases (3.1% and 8.7%, respectively). Furthermore, analysis of data from four studies has shown that EUS-guided liver abscess has a high clinical (90.7%) and technical success (90.7%) without significant complications. Similarly, EUS-guided interventions for the treatment of gastric varices (GV) have a high technical success (98%) and GV obliteration rates (84%), with low complications (15%) and rebleeding events (17%).

Research conclusions

The role of EUS in the liver disease is well established with promising accuracy and efficacy profile. We found that EUS-guided interventions are effective and safe in treating liver diseases.

Research perspectives

EUS in liver diseases is a promising technique with the potential to be considered as a first-line therapeutic and diagnostic option in selected cases.