Comparison of diagnostic performance of 19-gauge versus 22-gauge fine-needle biopsy needles for endoscopic ultrasound-guided liver biopsy: a systematic review and meta-analysis

Studies have compared 19-gauge (19G) and 22G needles for endoscopic ultrasound-guided liver biopsy (EUS-LB) and reported variable results. We conducted a meta-analysis to compare the outcomes of EUS-LB with 19G vs. 22G needles. We reviewed several databases from inception to 19 October 2025. Outcomes of interest were diagnostic yield, tissue adequacy, adverse events, complete portal tracts (CPTs), aggregate specimen length (ASL), and length of the longest fragment. Data were analyzed using a random-effects model. We found no significant difference in diagnostic yield [risk ratio: 1.11, 95% confidence interval (CI): 0.93–1.32], tissue adequacy (risk ratio: 1.47, 95% CI: 0.87–2.49), and adverse events (risk ratio: 1.22, 95% CI: 0.38–3.96) between groups. We found no significant difference in mean CPTs between groups. Mean ASL and length of the longest fragment were significantly longer in the 19G group. In conclusion, this meta-analysis demonstrates that most of the outcomes of EUS-LB were comparable between the 19G and 22G needle groups, except ASL and length of the longest fragment, which were longer in the 19G group.