https://pubmed.ncbi.nlm.nih.gov/34310440/

J Pediatr Gastroenterol Nutr. 2021 Jul 23.
doi: 10.1097/MPG.0000000000003249.Online ahead of print.

Safety, Feasibility, Yield, Diagnostic and Prognostic Implications of Transjugular Liver Biopsy in Children and Adolescents

Bikrant Bihari Lal 1, Vikrant Sood, Archana Rastogi, Amar Mukund, Rajeev Khanna, Manoj Kumar Sharma, Seema Alam

Abstract
Objectives: The objectives of the study were to evaluate the indications, feasibility, complications and clinical implications of transjugular liver biopsy (TJLB) in children.

Methods: Data of all TJLB performed in children less than 18 years old was retrieved from the computerized hospital information system. TJLB was done using a 19G quick-core needle biopsy system with 20 mm throw length. Hepatic venous pressure gradient was additionally measured in children with portal hypertension. A single pathologist reviewed all the biopsies again and provided structured information.

Results: A total of 102 children, including 5 with acute liver failure underwent TJLB with technical success in 101 (99%). A mean of 2.3 ± 0.9 passes (Range: 1 to 5) were taken for the biopsy. The most common indications for TJLB in our cohort were elevated INR >1.5 (66, 64.7%), ascites (46, 45.1%) and thrombocytopenia (platelet count < 60,000/cu.mm) (42, 41.2%). Mean size of the tissue received was 14.5 ± 5.6 mm with an average of 10.2 ± 4.7 portal tracts. Only 1 child developed major (category D) complication (hemobilia) and 12 (11.8%) developed minor complications post-procedure. Etiological diagnosis could be made in a total of 64 (63.9%) children undergoing TJLB, the most common diagnosis being autoimmune hepatitis (n = 31), non-cirrhotic portal fibrosis (n = 16) and drug-induced liver injury (n = 4).

Conclusion: TJLB is safe, feasible and helps make a diagnosis in close to 64% children allowing timely medical and/or surgical intervention. It is especially useful for diagnosis of autoimmune liver diseases, DILI and NCPF.