EUS-guided versus percutaneous spleen biopsy: Comparative safety and diagnostic performance in a tertiary center

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Background and Objectives: Percutaneous biopsy is the traditional method for diagnosing splenic lesions but carries a risk of hemorrhage due to the organ’s rich vascularity. EUS-guided biopsy has emerged as a minimally invasive alternative that may reduce bleeding risk. This study compared the safety and diagnostic performance of EUS-guided and percutaneous spleen biopsies. Methods: We retrospectively analyzed 91 patients who underwent splenic biopsy at a tertiary center between 2015 and 2023 (EUS, n = 63; percutaneous, n = 28). The primary outcome was the occurrence of procedure-related adverse events graded by the Adverse Events in Gastrointestinal Endoscopy (AGREE) classification. Secondary outcomes included tissue adequacy and diagnostic performance. Statistical analyses used Fisher’s and Boschloo tests, Firth-penalized logistic regression, and propensity-score overlap weighting to adjust for confounders. Results: Clinically relevant adverse events (AGREE grade ≥2) occurred among 0% of EUS-guided and 10.7% of percutaneous biopsies (absolute risk difference: −10.7%, 95% confidence interval: −21.1% to −0.3%; P = 0.029). After adjustment, EUS-guided biopsy remained independently associated with fewer major adverse events (adjusted odds ratio: 0.09, 95% confidence interval: 0.00 to 0.78; P = 0.047). Diagnostic sensitivity was comparable between EUS and percutaneous biopsy (86.4% vs. 93.3%; P = 0.74), with 100% specificity in both. Conclusion: EUS-guided spleen biopsy was associated with a lower rate of clinically relevant adverse events, maintaining comparable diagnostic accuracy. These findings suggest that EUS-guided biopsy is a safer and equally effective alternative for splenic tissue acquisition, warranting validation in larger prospective studies.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.