When would you consider use of EUS guided liver biopsy over percutaneous and/or transjugular?

If data (labs, imaging) are not entirely compelling for a primary parenchymal or biliary issue, then EUS liver biopsy can be an efficient approach in addition to ERCP (saving the need for separate biopsy in the event that ERCP is non diagnostic).

There are several advantages of EUS-guided liver biopsy, and the tissue samples that are obtained have been shown in multiple studies to be excellent, and rival or exceed the percutaneous route. It is also much easier on patients than an unsedated percutaneous biopsy.