21. Transjugular versus percutaneous liver biopsy in children: indication, feasibility, yield and complications

Abstract

Background and Aims: Liver biopsy is a valuable test for evaluation of children with liver disorders. Percutaneous biopsy (PB) is the first choice except in patients with contraindications where transjugular liver biopsy (TJLB) is recommended. 1 We evaluated the indication, yield, success and complications of TJLB in comparison to PB in children. Methods: Audit of all liver biopsies from November 2013 to March 2018 was done. All biopsies (TJLB or PB [percussion, real time USG guided or plugged method]) were done as inpatients, using 18G cutting needle and complications were noted.2 Biopsies were assessed for diagnostic yield (tissue length, number of portal tracts). Results: A total of 517 liver biopsies were performed, 67 (13%) TJLB [38 boys, age-139.2 ± 42 months] and 450 (87%) PB [250 boys, age-55 ± 59 months]. Amongst PB, 325 (72%) were by percussion, 102 (23%) by real time USG guidance and 23 (5%) were plugged biopsies. Indications for TJLB were coagulopathy (INR > 1.5, n = 21, 31%), thrombocytopenia (platelets < 60,000/cumm, n = 18, 27%) and both (n = 28, 42%). Technical success of TJLB and PB was similar (66/67 vs. 450/450; p = 0.7). The number of passes was significantly higher but the tissue was smaller, fragmented and had lesser number of portal tracts in TJLB as compared to PB. (Table 1) TJLB was more often inadequate than PB (18% vs. 2%, p < 0.001). Overall complications were seen in 19/517 (3.6%) patients, similar in TJLB and PB (4 [6%] vs. 15 [3.3%], p = 0.28). Major complications were supraventricular tachycardia (n-1) and hemoperitoneum (n-2). Minor complications included fever (n-9), local site pain (n-3), neck hematoma (n-1), subcapsular hematoma (n-2) and hypotension (n-1). The three types of PB were similar in histological adequacy and complications. Conclusions: TJLB is required in 13% children undergoing liver biopsies. TJLB is equally safe and successful but inferior in terms of tissue adequacy in comparison to PB. The authors have none to declare.