https://www.ncbi.nlm.nih.gov/pubmed/31821233 Liver biopsy

J Pediatr Gastroenterol Nutr. 2019 Dec 6. doi: 10.1097/MPG.0000000000002587. [Epub ahead of print]

Transjugular Versus Percutaneous Liver Biopsy in Children: Indication, Success, Yield and Complications.

Srivastava A1,2, Prasad D1,2, Panda I1, Yadav R2, Jain M1, Sarma MS1,2, Prasad R2, Poddar U1,2, Yachha SK1,2.

Abstract

BACKGROUND/OBJECTIVE:
Percutaneous biopsy (PB) and transjugular liver biopsy (TJLB) are two main ways of obtaining liver tissue. We evaluated the indications, success rate, tissue yield and complications of TJLB in comparison to PB in children.

METHODS:
Electronic records of children undergoing liver biopsy (LB) were reviewed. Clinico- laboratory data including indication, type of biopsy, complications and tissue yield (length, number of complete portal tracts [CPT]) were noted.

RESULTS:
540 LB [indication: neonatal cholestasis (42.9%), chronic liver disease (43.7%), liver failure (3.7%), focal lesions (3.3%) and others (6.3%)] were done. 473 were PB (317 boys, 14[1-216] months) done by percussion [322 (68.0%)], real-time ultrasound guidance [125 (26.4%)] or plugged method [26 (5.5%)]. 67 (12.4%) were TJLB (38 boys, 140[24-216] months), done in patients with contraindications for PB. Technical success (67/68 vs. 473/473; p=0.7) and complications (4[6%]; vs. 15[3.3%]; p=0.2) of TJLB and PB were similar. Major complications (0.5%) included supraventricular tachycardia (n=1) in TJLB and hemoperitoneum (n=2) in PB. Tissue yield of TJLB was poorer in terms of length (1.0[0.2-2.0] vs. 1.1[0.4-2.1] cm; p<0.001), CPT (4[0-9] vs. 5[2-17]; p<0.001) and adequacy for reporting (56/67 vs. 459/473; p<0.001). Biopsy yield of <6 CPT was predicted by cirrhosis at histology and TJLB. No factor identified risk of complications with LB.

CONCLUSION:
LB is a safe procedure and only 12% children require TJLB due to contraindications of PB. Technical success and complications are similar but tissue yield is poorer in TJLB than PB. Presence of cirrhosis and TJLB adversely affected tissue yield.