IOS Working Group Publishes Landmark International Consensus on Laparoscopic Liver Biopsy in Cell Reports Medicine

IOS Working Group Publishes Landmark International Consensus on Laparoscopic Liver Biopsy in Cell Reports Medicine

FOR IMMEDIATE RELEASE

International Obesity Society (IOS) – The IOS Working Group on Steatotic Liver Disease has achieved a significant milestone with the publication of the first international, multidisciplinary consensus statement on Laparoscopic Liver Biopsy (LLB) in the prestigious journal Cell Reports Medicine. This landmark document, developed through a rigorous Delphi process involving 45 global experts from six continents, establishes standardized protocols to enhance the safety, accuracy, and appropriate use of LLB in complex clinical scenarios.

Addressing a Critical Gap in Liver Disease Management

Liver biopsy remains a cornerstone for diagnosing and staging liver diseases, including steatotic liver disease (SLD). While percutaneous biopsy is common, it can be technically challenging or contraindicated in patients with conditions like morbid obesity, coagulopathy, or complex anatomical lesions. Laparoscopic Liver Biopsy offers a valuable alternative by allowing direct visualization of the liver surface, targeted sampling, and immediate hemostasis. However, clinical practices have varied widely due to the lack of international standards. This consensus, led by co-first authors Si-Yi Lei and Yu Han, co-corresponding authors Wah Yang, James Neuberger and Ming-Hua Zheng, and an esteemed panel, fills this critical void.

A Rigorous, Global Collaborative Effort

The consensus is the result of a three-round modified Delphi process, culminating in 46 statements across six core domains. All statements achieved strong agreement (≥78%), with 25 receiving unanimous (100%) approval. The panel included world-renowned specialists in hepatology, hepatobiliary surgery, gastrointestinal surgery, and metabolic & bariatric surgery, ensuring a comprehensive and practical perspective.

Key Consensus Recommendations for Clinical Practice

The consensus provides clear, actionable guidance on when and how to perform LLB:

1. Defined Application Scenarios: LLB is recommended when other approaches (percutaneous, transvenous, or endoscopic ultrasound-guided) are limited or unavailable. Key indications include:

   • Challenging Patient Anatomy: Morbid obesity, narrow intercostal spaces, or hepatic lobe agenesis/atrophy.

     
     

   • Complex Anatomical Lesions: Nodules adjacent to the gallbladder or hepatic hilum, subdiaphragmatic lesions, and caudate lobe lesions where percutaneous biopsy carries higher risks.

     
     

   • Need for Multiple-Site Sampling: For evaluating heterogeneous or multifocal disease, reducing sampling error.

     
     

   • Intraoperative Opportunistic Biopsy: To assess underlying liver disease or incidental findings during other laparoscopic procedures.

   
   

2. Management of High-Risk Scenarios: The consensus outlines contraindications and cautions for LLB, such as in patients with severe cardiopulmonary insufficiency, uncorrected coagulopathy, uncontrolled intra-abdominal infection, or shock. It emphasizes the necessity of a multidisciplinary team (MDT) assessment for complex cases.

   
   

3. Standardized Procedural Protocols: Detailed recommendations are provided for preoperative assessment, surgical technique, complication management, and post-procedure care to ensure patient safety and diagnostic yield.

Significance for the Steatotic Liver Disease Community

"This consensus is a pivotal step forward for the field," stated the working group. "For our patients with obesity and related metabolic liver diseases, who often present with challenging anatomies or comorbidities, LLB can be a safer and more effective diagnostic tool when standardized correctly. This document empowers clinicians worldwide with evidence-based guidelines to optimize patient selection and procedural execution."

The publication underscores the IOS's commitment to advancing integrated care for obesity and its complications. By standardizing LLB practice, the consensus aims to:

• Improve diagnostic accuracy for complex liver conditions, including advanced SLD.

  
  

• Enhance patient safety by defining clear indications and contraindications.

  
  

• Support clinical decision-making for hepatologists and surgeons globally.

  
  

• Facilitate high-quality tissue acquisition for crucial pathological and research analyses.

Access the Full Consensus

The open-access article, "An international multidisciplinary consensus statement on laparoscopic liver biopsy," is now available online in Cell Reports Medicine: https://doi.org/10.1016/j.xcrm.2026.102831

How to cite this paper

Lei SY, Han Y, Rockey DC, Alswat K, Wong VW, Jumaev N, Toro-Huamanchumo CJ, Taha S, El-Kassas M, George J, Muthiah M, Ghanem O, Yoneda M, Hang DV, Sebastiani G, Papatheodoridis G, Abu-Abeid A, Robertson AG, Kim SH, Weiner R, Mahawar K, Shabbir A, Kermansaravi M, Rajan R, Seki Y, Taskin HE, Shikora S, Oliveros E, Parmar C, Cheng Q, Thaher O, Ruiz-Úcar E, Oviedo R, Ribeiro R, Musella M, Ramos AC, Ryu SW, Abdelbaki T, Lee WJ, Chan MP, Garcia Flores JE, Skinovsky J, Madkhali A, Weiner S, Tacke F, Yang W, Neuberger J, Zheng MH; International Obesity Society Working Group on Steatotic Liver Disease. An international multidisciplinary consensus statement on laparoscopic liver biopsy. Cell Rep Med. 2026 May 22:102831. doi: 10.1016/j.xcrm.2026.102831. Epub ahead of print. PMID: 42173098.

Consortia

The members of the International Obesity Society Working Group on Steatotic Liver Disease are Adam Abu-Abeid, Ahmad Madkhali, Almino C. Ramos, Andrew G Robertson, Bai-Zhen Deqing, Bao-Xin Qian, Bei-Bei Qin, Ben-Li jia, Bi-Hui Zhong, Bo Li, Cai-Yun Wen, Carlos Jesus Toro-Huamanchumo, Chetan Parmar, Chen-Hui Ye, Chen-Xiao Huang, Cheng-Cheng Feng, Cheng-Long Zhang, Cheng-Lv Hong, Cheng-Zhi Lu, Chun-Yi He, Dan-Qin Sun, De-Liang Shen, Don C. Rockey, Edward Oliveros, Elena Ruiz-Úcar, En-Qiang Chen, Fan-Pu Ji, Fang-Jie Hou, Fei Guo, Feng Gao, Feng-Mei Wang, Frank Tacke, Gang Li, Ge Yu, George Papatheodoridis, Giada Sebastiani, Gong Feng, Guan-Yue Su, Gui-Qi Wang, Hai-Bing Jiang, Hai-Yang Yuan, Halit Eren Taskin, Dao Viet Hang, Hao Guan, Hao-Tian Zhang, Hong Peng, Hong-Ju Yang, Hong-Lei Ma, Hong-Xia Liang, Hong-Yan Zhang, Huai Zhang, Hua-Wu Yang, Hui Yang, Jacob George, James Neuberger, James Skinovsky, Jia Li, Jia-Ke Tang, Jian-Dong Chen, Jian-Li Han, Jia-Xing Zou, Jie Deng, Jie You, Jie Zhu, Jin Chai, Jin Li, Jing Liu, Jing-Ling Zhao, Jing-Feng Gu, Jose Eduardo Garcia Flores, Jun-Feng Li, Jun-Kang Chen, Jun-Zhao Ye, Junmei Wu, Kai-Wen Miao, Kamal Mahawar, Kebinuer Tuerxun, Kenneth Iden Zheng, Khalid Alswat, Lei Cui, Lei Miao, Li Ma, Li-Gai Liu, Li-Li Chen, Li-Ting Zhang, Li-Xia Yang, Li-You Lian, Liang Deng, Liang-Jie Tang, Man Pan Chan, Mario Musella, Mark Muthiah, Masato Yoneda, Mei Cao, Meng-Juan Zhang, Mao-Jie Zhang, Ming-Feng Xia, Ming-Hua Zheng, Ming-Wei Wang, Mohammad Kermansaravi, Morigen, Muhammad Zulqarnain, Na Tian, Ni Zhang, Ning Geng, Nozim Jumaev, Omar Ghanem, Omar Thaher, Ou-Yang Huang, Pei-Wu Zhu, Peng-Fei Cheng, Qi Wang, Qi-Han Zhu, Qian Tong, Qian Wang, Qian-Cheng He, Qiang Luo, Qin-Fen Chen, Qing Ye, Qiong-Yue Fan, Qiu-Ye Cheng, Rafael Santos Rios, Ren Cheng-Han Fan, Ren-Yi Su, Reynu Rajan, Rodolfo Oviedo, Rui Ribeiro, Rui Tao, Rui Xiang, Rui Zhang, Ruo-Nan Liu, Sang Chen, Sang Hyun Kim, Scott Shikora, Seung-wan Ryu, Shali Shalaimaiti, Shan-Shan Huang, Shao-Zhuang Liu, Shi-Yun Hu, Shu-Jun Jiang, Shuai-Ran Zhang, Shun-Ping Chen, Si-Yi Lei, Song Yang, Song-Hao Hu, Stephen Ka-Kei Ng, Sui-Dan Chen, Su Lin, Sylvia Weiner, Tamer Abdelbaki, Tian-Chu Wu, Tie Xiao, Ting-Ran Ye, Vincent Wai-Sun Wong, Wah Yang, Wei Jei Lee, Wei Xie, Wen Zheng, Wen-Xin Zheng, Wen-Ying Chen, Wen-Yue Liu, Xian-Lun Li, Xiang-Yuan Pu, Xiao Liang, Xiao-Dong Wang, Xiao-Dong Zhou, Xiao-Fan Miao, Xiao-Na Shen, Xiao-Ping Peng, Xiao-Ping Wu, Xiao-Qi Wang, Xiao-Qian Zhang, Xiao-Yan Pan, Xiao-Yong Zheng, Xiao-Zhi Jin, Xiao-Dong Shan, Xiao-Gang Li, Xin-Gang Zhang, Xin-Hua Luo, Xin-Lei Zhang, Xin-Yi Sun, Xin-Zhe Jin, Xu-Fen Zeng, Xi-Qiao Zhou, Xi-Xi Wu, Xi-Xi Xiao, Ya Lin, Ya-Kun Jiang, Ya-Qin Liang, Yan Huang, Yan Li, Yan-Hang Gao, Yan-Liang Zhang, Yang Yu, Yang Zhao, Yang-Yang Li, Yang-Yang Teng, Yao-Hong Song, Yi Jin, Yi-Jia Huang, Yi-Ling Li, Yi-Long Man, Yi-Qiu Dai, Yi-Xuan Wei, Ying-Wu Liu, Ying-Ying Cao, Yosuke Seki, Yong-Ji Li, Yong-Ning Xin, Yong-Qian Cai, Yong-Qiang Wang, Yong-Sheng Xia, You-Fu He, Yu Han, Yu-Bao Zheng, Yu-Feng Gao, Yu-Jie Zhou, Yu Shi, Yu-Ting Li, Yuan Zhang, Yuan-Jun Yang, Yuan-Yuan Ren, Yue-Yan Hu, Ze-Feng Xia, Zhao-Hui Liu, Zhen-Qi Ma, Zheng-Jie Lu, Zhi-Juan Dai, Zhong-Wei Chen, and Zhong Ye.

Acknowledgments

This work was funded by grants from Noncommunicable Chronic Diseases-National Science and Technology Major Project (2026ZD0557000), National Key R&D Program of China (2023YFA1800801), and the National Natural Science Foundation of China (82070588, 82370577). J.G. is supported by the Robert W. Storr Bequest to the Sydney Medical Foundation, University of Sydney; National Health and Medical Research Council of Australia (APP1053206); Investigator and MRFF grants (APP2032407, NCRI000183, APP2016215, APP2010795, and APP1196492); and a Cancer Institute, NSW grant (2021/ATRG2028). C.J.T-H. is supported by the Forrest Research Foundation Scholarship and the Edith Cowan University (ECU) Higher Degree by Research Scholarship. M. Muthiah is supported by the Singapore Ministry of Health through the National Medical Research Council (NMRC) Office, MOH Holdings Pte Ltd under the NMRC Clinician Scientist-Individual Research Grant (MOH-001228), and NMRC Clinician Scientist Award (MOH-001631), as well as the National Research Foundation, Singapore (NRF) under the NMRC Open Fund-Large Collaborative Grant (MOH-001325) and administered by the Singapore Ministry of Health through the NMRC Office, MOH Holdings Pte Ltd. The authors sincerely thank Xiao-Dong Zhou, Xu-Fen Zeng, and Wen-Yue Liu for their invaluable methodological guidance. We also appreciate Li-Li Chen for meticulous illustration design, Sui-Dan Chen for expertise in pathological slide preparation, and Zhong-Wei Chen for providing high-resolution imaging data, all of which supported the quality of this work.

Author contributions

Conceptualization and methodology, S.-Y.L., Y.H., W.Y., J.N., and M.-H.Z.; Questionnaire design and writing – original draft, S.-Y.L., F.T., W.Y., J.N., M.-H.Z. and Y.H.; writing – review and editing, all authors; supervision, W.Y., J.N., and M.-H.Z.; project administration, S.-Y.L., Y.H., and M.-H.Z.; investigation, D.C.R., K.A., V.W.-S.W., N.J., C.J.T.-H., S.T., M.E.-K., J.G., M. Muthiah, O.G., M.Y., D.V.H., G.S., G.P., A.A.-A., A.G.R., S.H.K., R.W., K.M., A.S., M.K., R. Rajan, Y.S., H.E.T., S.S., E.O., C.P., Q.C., O.T., E.R.-Ú., R.O., R. Ribeiro, M. Musella, A.C.R., S.-w.R., T.A., W.J.L., M.P.C., J.E.G.F., J.S., A.M., S.W., W.Y., J.N., and M.-H.Z.; All authors reviewed and commented on the manuscript and approved the final version.

About the International Obesity Society (IOS) Working Group on Steatotic Liver Disease:

This working group is dedicated to fostering collaborative research, promoting best practices, and improving patient outcomes in steatotic liver disease, a major hepatic complication of obesity. The group brings together global experts to translate scientific evidence into clinical guidelines and educational initiatives.

About the International Obesity Society (IOS):

The IOS is a global organization dedicated to creating a collaborative research ecosystem, promoting excellence in integrated patient care, and defining the future of obesity treatment through innovation and education. We connect experts across disciplines to address the full spectrum of obesity-related health challenges.