Complications of percutaneous liver biopsy with Klatskin needles: a 36‐year single‐centre experience

Abstract

Background Liver biopsy is the gold standard in evaluating liver diseases but is susceptible to complications. Safety data on aspiration needle biopsies remains limited. Aim To evaluate the safety of percutaneous liver biopsy performed with Klatskin needle. Methods Clinical and biochemical data were retrospectively retrieved from sequential subjects who underwent liver biopsy with Klatskin needle from 1978 to 2015. Subjects with complications underwent thorough chart reviews for hospital course. Results Of 3,357 biopsies performed, complications occurred in 135(4%) biopsies with 33(1%) resulting in major complications. Severe pain occurred in 78(2.3%) subjects and bleeding occurred in 21(0.6%) subjects. Biliary injury occurred in 8(0.2%) biopsies. Three subjects died as a result of massive intraperitoneal bleeding. Compared to viral hepatitis, biopsies performed with certain diagnosis had significantly higher odds of major complications: NRH (OR:17), DILI (OR:20), GVHD (OR:32) and HCC (OR:34). Subjects with major complications had higher pre-biopsy median AP (153 vs 78 U/L, p<0.001), ALT (105 vs 64 U/L, p<0.05), AST (62 vs 47 U/L, p<0.02), along with marginally lower total bilirubin (1.0 vs 0.7 mg/dL) and albumin (3.7 vs 4.0 g/dL, p<0.001). By multivariate backward logistic regression, platelets ≤100 K/uL and aPTT>35 were independent risk factors of post-biopsy bleeding. Conclusion Klatskin needle liver biopsies are safe with rare procedural morbidity. Our data suggests certain acutely ill subjects and those with systemic illnesses may be at higher risk of major complications. Clinicians should weigh the risks and benefits of liver biopsy in these patients with other alternative approaches.

Prevention and Management of Bleeding Risk Related to Invasive Procedures in Cirrhosis

“…A recent large study analyzing 3,357 percutaneous liver biopsies performed with Klatskin needle in patients with liver disease (including advanced CLD) across a 36-year period 56 reported a very low risk of bleeding (0.6%). This study identified worse liver function (higher total bilirubin and lower albumin levels) rather than coagulopathy as predictor of bleeding.…”

Accuracy of real-time shear wave elastography in staging hepatic fibrosis: a meta-analysis

“…Currently, percutaneous liver biopsy is the standard of reference for clinical assessment of hepatic fibrosis [3,4]. However, it is invasive and may cause complications because of puncture, although the assessment is accurate [5]. A reliable noninvasive technique is needed for detecting and staging fibrosis as well for as evaluating treatment response [6].…”

Letter: complications of percutaneous liver biopsy with Klatskin needles—methodological issues. Authors’ Reply

“…We appreciate the interest in our recent manuscript (1) by Ayubi et al (2) and are grateful for the opportunity to respond.…”

“… The authors’ declarations of personal and financial interests are unchanged from those in the original article(1). …”