Transjugular liver biopsy: a review of 461 biopsies.

Abstract

Transjugular liver biopsy was performed in a large series of patients for whom routine percutaneous biopsy was contraindicated; most of the patients had severe liver disease associated with coagulopathies or massive ascites. Of the 461 biopsies performed over a 7-year period, adequate specimens for histologic diagnosis were obtained in 425; in 14 (3.3%), the biopsy provided a false-negative result. Minor complications such as neck pain, hematoma at the puncture site, or pyrexia occurred in 79 patients (17.1%). Serious complications were encountered in six patients (1.3%) (two with cardiac arrhythmias; four with intraperitoneal hemorrhage following capsular perforation), with an overall mortality rate for the series of 0.22%. Modification of the technique--taking the biopsy with the catheter positioned centrally rather than wedged peripherally--has reduced the occurrence of capsular perforation without affecting the success rate. Transjugular liver biopsy is a valuable technique that provides diagnostic information in a high proportion of cases in which conventional percutaneous biopsy is contraindicated.

Transjugular liver biopsy: histological diagnosis success comparing the trucut to the modified aspiration Ross needle

“…The procedure was then performed successfully via the left IJV. The use of ultrasonography had already been suggested in a similar situation (3,13,28) .…”

“…Percutaneous liver biopsy is the standard technique, but it is contraindicated in patients presenting abnormal blood coagulation or massive ascites. Transjugular liver biopsy (TJLB) constitutes a wellestablished alternative in these cases (11,13,23) and is also useful for sampling liver tissue for several other purposes (5,11,22) .…”

“…However, excessive fragmentation of liver specimens was observed even after the change to a reversed bevel needle and the addition of an inner stylet (10,13,15,23) . A modified version of the percutaneous Vim-Silverman side-cutting needle -the trucut needle -has been proposed for TJLB with the aim of providing larger and less fragmented specimens (7,16,25) .…”

Complications of Liver Biopsy

“…The reported complication for the transjugular is as high as 20% (Grant, et al 1999) with major complications occurring between 1.3 to 2.7% (Gamble, Colapinto, Stronell, Colman andBlendis 1985, McAfee, Keeffe, Lee andRosch 1992). However, the most recent review of the literature reports a complication rate of 6.7% in adult series, comparable to complication rates reported in other series (Thampanitchawong, et al 1999).…”

The use of laparoscopic liver biopsies in pediatric patients with hepatic dysfunction following allogeneic hematopoietic stem cell transplantation

“…5 By contrast, procurement of liver tissue via a transjugular approach, in which access to the liver is obtained via the hepatic vein, is associated with a reduced risk of bleeding. 9,19,20 The transjugular approach offers other advantages as well, including the ability to perform imaging studies of the hepatic venous system and determining intrahepatic pressures. 9,12,21 While this procedure has been used to evaluate hepatic dysfunction in adult HSCT patients, studies in pediatric HSCT recipients are limited.…”