There remains an important role for liver biopsy in the management of liver disorders. Image-guided liver biopsy can be obtained with percutaneous or transjugular approaches. Real-time image-guided liver biopsy can be accomplished with endoscopic ultrasound (EUS). EUS-guided liver biopsy (EUS-LB) has emerged as a safe means of obtaining liver biopsy. EUS-LB confers several advantages over other methods, including the ability to target both lobes of the liver, increased patient comfort and decreased apprehension during the procedure, and shorter recovery time after the biopsy. Future development of technology that allows for EUS-guided portal pressure measurement could further drive EUS-LB use.