Diagnostic outcome and safety of plugged liver biopsy in high-risk patients: a systematic review and meta-analysis

Abstract

Background Percutaneous liver biopsy is the gold standard test for the assessment of liver disease. In patients with coagulopathy, ascites, post-transplantation, and hypervascular tumors, biopsy is associated with increased risk of adverse events (AEs). Transjugular liver biopsy (TJLB) is recommended in these conditions but is expensive and unavailable at many centers. Plugged liver biopsy (PLB) provides an alternate diagnostic modality in these high-risk cases. Purpose To analyze the pooled diagnostic outcome and safety of PLB in high-risk cases. Material and Methods A literature search of various databases from January 1990 to July 2022 was conducted for studies evaluating the outcome of PLB in high-risk cases. The primary outcomes were pooled sample adequacy and AEs. Pooled event rates across studies were expressed with summative statistics. Results A total of 17 studies (2329 patients) were included in the meta-analysis. The pooled proportion of sample adequacy was 98.9% (95% confidence interval [CI]=98.2–99.6). Severe AEs, major bleeding, and minor AEs were seen in 0.7% (95% CI=0.1–1.3), 0.4% (95% CI=0.1–0.8), and 11.5% (95% CI=2.4–20.6) of the patients. There was only one reported mortality, giving a pooled incidence of 0.0002% (95% CI=0.0–0.0038). Compared to TJLB (5 studies, n = 336), there was no difference in either sample adequacy (odds ratio [OR]=2.34, 95% CI=0.83–6.58) or risk of serious AEs (OR=0.47, 95% CI=0.173–1.31). Conclusion PLB can be safely performed on patients with coagulopathy and/or ascites with high sample adequacy rates and low incidence of AEs and mortality.