Transjugular Versus Percutaneous Liver Biopsy in Children

Abstract

Background/Objective: Percutaneous biopsy (PB) and transjugular liver biopsy (TJLB) are 2 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 and number of complete portal tracts [CPT]) were noted. Results: Five hundred forty 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. Four hundred seventy-three were PB (317 boys, 14 [1--216] months) done by percussion (322 [68%]), real-time ultrasound guidance (125 [26.4%]), or plugged method [26 (5.5%)]. Sixty-seven (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. Conclusions: LB is a safe procedure and only 12% children require TJLB because of 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.

Veno-occlusive Disease in HSCT Patients: Consensus-based Recommendations for Risk Assessment, Diagnosis, and Management by the GITMO Group

“…In pediatric patients, especially in infants and toddlers, a transjugular biopsy should be avoided, because it often requires a sedation/anesthesia, and it is potentially dangerous in critical patients. 54,55 In particular, a single-center experience 54 found a high incidence of severe complications resulting in the procedure being contraindicated in pediatric patients. 11 In conclusion, although liver biopsy is potentially very useful for diagnostic purposes, the risks associated with the procedure, make this diagnostic tool somewhat unappealing.…”

Liver Interventions in Children

“…of adequacy for pathology have been inconsistent, [37][38][39] and at our institution, pathologists prefer percutaneous samples for most indications. As with adults, a normal gradient is PSG to be <5 mm Hg.…”

Hospital Utilization, Treatment Modalities, and Mortality Using Different Biopsy Methods in Infants With Biliary Atresia

“…Percutaneous liver biopsies are less expensive and less invasive and can be done either blind utilizing a percussion-guided approach or with ultrasound guidance via a suction needle. Lastly, the transjugular approach is used in patients with coagulopathies and a high risk of bleeding and can have inconsistent samples, so they are rarely done [ 13 , 14 , 16 ]. Though there is a movement in pediatric gastroenterology to find alternative methods for diagnosing other cholestatic diseases, the ability to identify biliary atresia with a high specificity remains a challenge.…”