Needle Types and Diagnostic Accuracy in EUS-Guided Liver Biopsy: A Systematic Review and Network Meta-Analysis

Background: The optimal needle for endoscopic ultrasound (EUS)-guided liver biopsy (LB) remains uncertain. Methods: We conducted a network meta-analysis that integrated both direct and indirect comparisons among various needles. Our analysis included five randomized controlled trials (RCTs) involving 251 patients, which compared 19G fine-needle aspiration (FNA), 19G Franseen fine-needle biopsy (FNB), 19G Fork-tip FNB, 22G Franseen FNB, and 22G Fork-tip FNB. The primary outcomes focused on the total specimen length and the number of complete portal tracts (CPTs). Results were presented as mean difference (MD) or risk ratio (RR) with 95% confidence intervals (CIs). Results: The 19G Fork-tip and 19G Franseen needles were found to be significantly superior to the others in terms of total specimen length and CPT count. No differences were observed between the 19G FNA and the 22G Franseen or Fork-tip needles. SUCRA ranking indicated that the 19G Franseen and 19G Fork-tip FNB were the top-performing needles, with SUCRA scores of 0.91 and 0.83 for specimen length, and 0.85 and 0.82 for CPTs. No severe adverse events were reported. The quality of evidence was generally considered low due to bias risk and imprecision. Conclusions: The 19G Franseen and Fork-tip FNB showed favorable results but further RCTs are needed to confirm these results.