A new approach to timely clinical guidance, EXPOs combine targeted evidence review with expert interpretation and consensus to support informed clinical decision-making.
ALEXANDRIA, Va., Oct.15, 2026 — The American Association for the Study of Liver Diseases (AASLD) today announced the publication of its first-ever Expert-Based Practice Opinion (EXPO), marking the launch of a new type of clinical resource designed to provide timely, expert-informed recommendations for areas of hepatology where evidence is limited, emerging or evolving too rapidly to support a formal GRADE-based Practice Guideline.
Published in HEPATOLOGY, the inaugural AASLD EXPO: Liver Biopsy provides expert opinion statements addressing the contemporary role of liver biopsy, including when it should be considered, selection of biopsy technique, safety and monitoring, specimen adequacy and considerations for pediatric patients. The EXPO updates AASLD’s previous guidance on liver biopsy and reflects significant changes in clinical practice, including advances in noninvasive liver disease assessment and the emergence of endoscopic ultrasound-guided liver biopsy (EUS-LB).
Liver biopsy has been a cornerstone of hepatology for approximately 70 years, providing direct histologic assessment of liver tissue. While advances in noninvasive testing have substantially reduced the need for biopsy in some settings, liver biopsy continues to play an important role in diagnosis, disease staging, and clinical management.
The new EXPO identifies three primary indications for liver biopsy: establishing a diagnosis, staging the severity of inflammation and/or fibrosis, and informing clinical management. It also examines percutaneous, transjugular, and EUS-guided approaches, with the appropriate technique depending on factors including local expertise, patient-specific considerations, anatomy, ascites or coagulopathy, and the need for additional procedures or measurements.
Among the EXPO’s expert opinion statements:
- Liver biopsy should be considered in all patients with unexplained abnormal liver tests, when noninvasive fibrosis testing is uncertain or discordant, and when histologic assessment will inform clinical management.
- Selection of which liver biopsy technique to use should depends on multiple factors, including the availability of local expertise and patient-specific factors such as ascites, coagulopathy, concurrent indications, and patient preference.
- Imaging localization should be used immediately before or during percutaneous liver biopsy in adults.
- Clear communication between clinicians and pathologists and assessment of specimen adequacy are important to obtain clinically useful information from liver biopsy.
- The EXPO also provides recommendations specific to liver biopsy in infants and children, including considerations related to patient age and size, sedation, anatomy, coagulopathy and local expertise.
“This EXPO also looks at how we use liver biopsy today, and as well toward the future of liver biopsy, pointing out that advances such as artificial intelligence and multi-omics approaches may further enhance the information we gain from tissue,” said Don C. Rockey, MD, FAASLD. “At the same time, the evolving role of EUS-LB and noninvasive liver disease assessments is reshaping how biopsy and histopathology fit within a broader, increasingly sophisticated approach to evaluating liver disease.”
The AASLD EXPO: Liver Biopsy was developed by Elizabeth C. Verna, MD, MS, FAASLD; Douglas G. Adler, MD; Matthew R. Kappus, MD; Elizabeth B. Rand, MD; Elliot B. Tapper, MD, FAASLD; and Don C. Rockey, MD, FAASLD.
View the AASLD EXPO: Liver Biopsy article in HEPATOLOGY, the EXPO commentary from the AASLD Practice Guidelines Committee, and EXPO: Liver Biopsy video.
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About AASLD
The American Association for the Study of Liver Diseases (AASLD) is the leading organization of scientists and health care professionals committed to preventing and curing liver disease. AASLD fosters research that leads to improved treatment options for millions of liver disease patients and advances the science and practice of hepatology through educational conferences, training programs, professional publications, and partnerships with government agencies and sister societies.
About HEPATOLOGY
The premier publication in the field of liver disease, HEPATOLOGY publishes original, peer-reviewed articles concerning all aspects of liver structure, function and disease. Each month, the distinguished Editorial Board monitors and selects only the best articles on subjects such as immunology, chronic hepatitis, viral hepatitis, cirrhosis, genetic and metabolic liver diseases and their complications, liver cancer, and drug metabolism. Follow the journal on X at @HEP_Journal.