Percutaneous Liver Biopsy In Patients Research Articles

Ultrasound-Guided Plugged Percutaneous Liver Biopsy in Patients with a High Risk of Bleeding in An Under-Resourced Community

Background: The liver biopsy is the traditional gold standard for assessing liver diseases. Bleeding is the most feared complication with transcutaneous liver biopsy, with major bleed occurring in 0.8 % - 2%. Transcutaneous liver biopsy should be avoided in patients with a high risk of bleeding and those with moderate to severe ascites. Transjugular liver biopsy (TJLB) is recommended in high-risk cases; however, the procedure is expensive, technically demanding, and is not routinely available in most centers; moreover, TJLB has limitations in the focal lesion.

Value and risk of percutaneous liver biopsy in patients with cirrhosis and clinical suspicion of autoimmune hepatitis

ObjectiveThe decision regarding whether to perform a liver biopsy in patients with cirrhosis and clinically suspected autoimmune hepatitis (AIH) remains a challenge. This study aimed to assess the utility and...

Endoscopic Ultrasound-Guided Liver Biopsy, Is It Ready for Prime Time?

We would like to further analyze several different issues that were addressed in the manuscript “The efficacy and safety of endoscopic ultrasound-guided liver biopsy versus percutaneous liver biopsy in patients with chronic liver disease: a retrospective single-center study.”

The efficacy and safety of endoscopic ultrasound-guided liver biopsy versus percutaneous liver biopsy in patients with chronic liver disease: a retrospective single-center study

There is limited literature on endoscopic ultrasound-guided liver biopsy (EUS-LB), a new method of obtaining liver biopsy (LB). We conducted a retrospective study of the efficacy and safety of EUS-LB compared to percutaneous liver biopsy (PC-LB) in patients with chronic liver disease at our center between January 2018 and August 2019. Thirty patients underwent EUS-LB and 60 patients underwent PC-LB were identified (median follow-up post-LB was 8days; interquartile range (IQR), 3-5days). The median number of portal tracts was significantly higher in the PC-LB group (13 vs. 5; P < 0.0001). A histologic diagnosis was established in 93% of the EUS-LB group, compared to 100% in the PC-LB group (P = 0.841). Patients in EUS-LB group had significantly shorter hospital stay (median time of hospital stay was 3 vs. 4.2h in the EUS-LB vs. PC-LB group, respectively; P = 0.004) and reported less pain compared to PC-LB group (median pain score was 0 vs. 3.5; P = 0.0009). EUS-LB were performed using a 19-gauge (n = 27) or 22-gauge (n = 3); there was a tendency towards higher number of portal tracts in the 22- vs. the 19-gauge needle group (6 vs. 5; P = 0.501). No patient in either group had significant adverse events such as bleeding or death. EUS-LB is safe and is associated with less pain, shorter hospital stay, and high diagnostic yield (93%) compared to PC-LB. Randomized trials are needed to standardize the utility of EUS-LB.

PTU-013 Single use of romiplostim thrombopoietin analogue (TPO) in severe thrombocytopaenia for outpatient percutaneous liver biopsy in patients with chronic liver disease (CLD): A randomised double blinded prospective clinical pilot trial

IntroductionThrombocytopaenia is a common entity in CLD with or without cirrhosis. Liver biopsy is the gold standard for diagnosis and prognosis of CLD. Platelet count is imperative before percutaneous liver...

Single Use of Romiplostim Thrombopoietin Analogue (TPO) in Severe Thrombocytopenia for Outpatient Percutaneous Liver Biopsy in Patients with Chronic Liver Disease (CLD) - A Randomized Double Blinded Prospective Clinical Pilot Trial: 2011 ACG Presidential Poster

Single Use of Romiplostim Thrombopoietin Analogue (TPO) in Severe Thrombocytopenia for Outpatient Percutaneous Liver Biopsy in Patients with Chronic Liver Disease (CLD) - A Randomized Double Blinded Prospective Clinical Pilot Trial: 2011 ACG Presidential Poster

Complications and Efficiency of Liver Biopsies using the Tru-Cut Biopsy Gun

The study aimed to evaluate the complications and quality of the specimens of percutaneous liver biopsy in patients with chronic viral hepatitis who were scheduled for treatment and also to evaluate the contribution of the knowledge of ultrasound guided (USG) biopsy localization to the existing data. Liver biopsies conducted at our clinic between 2003 and 2008 were retrospectively evaluated. In 53.8% of the cases, hepatobiliary USG was performed to mark the localization of the biopsy site. An automatically triggered Tru-Cut biopsy gun was used. Biopsies were taken from the livers of 236 patients (46.6% male, 53.4% female) with a mean age of 47.1 +/- 12.5 years. The majority of patients had hepatitis C (61.9%); 1.6% experienced major complications (3 patient biliary peritonitis, 1 patient liver bleeding); 52.1% of the samples were > or = 1 cm in length; And 69.7% of the biopsy samples with specified portal area had > or = 4 portal areas. There was no statistically significant difference between the patients with localized and non-localized biopsy site in terms of major complications and length of biopsy samples ( respectively p = 1.000, p = 0.209 ). We believe that percutaneous liver biopsy using Tru-Cut biopsy gun can be performed safely, with complications in 1.6% of the procedures. The length of the biopsy specimen is shorter than ideal values. Evaluation of the patients with and without USG-guided biopsy revealed no significant difference in terms of major complications and specimen size.

Supra-hepatic Gallbladder in a Patient with Cirrhosis of the Liver Secondary to Hemochromatosis

Purpose: Suprahepatic gallbladder is a rare type of gallbladder ectopia. This presentation could be associated with several types of abnormalities, i.e., right liver lobe agenesis, abnormally mobile gallbladder, diaphragmatic eventration, inversion of the liver and hypoplasia from cirrhosis, vascular injury and cholangiocarcinoma. Coexistence of suprahepatic gallbladder and macronodular cirrhosis is reported only once in the literature. All other cases were reported with the above mentioned abnormalities. We report a rare case of suprahepatic gallbladder in a patient with cirrhosis of liver secondary to hereditary hemochromatosis. A 63 year-old Caucasian male presented with chronic liver disease and encephalopathy. The patient's other comorbid conditions included diabetes mellitus and atrial flutter. Physical examination revealed bronze skin, bilateral gynecomastia, an enlarged liver, 4 to 5 cm below the right costal margin without splenomegaly. Laboratory evaluation revealed elevated ferritin at 6,265(units), AST 173(units), ALT 87(units), Alkaline Phosphatase 247(units) and bilirubin 3.6(units). The patient underwent a screening upper gastrointestinal endoscopy which revealed severe portal hypertensive gastropathy and two columns of grade II distal esophageal varices. The patient also underwent an ultrasound of the right upper quadrant and CT scan of the abdomen, which showed suprahepatic gallbladder without evidence of cholecystitis and cirrhosis of liver with tortuous intra-abdominal veins suggestive of portal hypertension. The HFE gene mutation analysis and CT guided liver biopsy confirmed hereditary hemochromatosis (C282Y homozygous) and cirrhosis with hepatocyte iron deposition The patient was treated with deferoxamine intramuscularly and phlebotomy and discharged home with follow up care. Cirrhosis of the liver due to hemochromatosis is a well-known condition, however, we present the only second-case of coexistence of cirrhosis in a patient with suprahepatic gallbladder. Extreme caution should be exercised before considering percutaneous liver biopsy in patients with cirrhosis of the liver as occasionally the hepatic flexure of the colon may interpose between the liver and the right hemidiaphragm making the diagnosis and biopsy difficult. Radiologic imaging modalities should be done prior to liver biopsy in such patients.

Use of Recombinant Factor VIIa to Correct the Coagulation Status of Individuals with Advanced Liver Disease Prior to a Percutaneous Liver Biopsy

Percutaneous liver biopsies are used to grade and stage liver disease and are also useful in monitoring the progress of liver disease over time as well as the response to medical therapies. The present study was undertaken to assess the effectiveness of recombinant factor VIIa as a means of transiently correcting the coagulopathy, enabling the safe performance of a percutaneous liver biopsy in patients in whom the use of fresh-frozen plasma is not possible without precipitating pulmonary edema or who have a treatment induced (iatrogenic) coagulopathy. The subjects of this report consisted of 18 consecutive individuals with advanced disease induced, and 15 with a therapeutic iatrogenic-induced, coagulopathy. All biopsies were performed by a single hepatologist. Before and 6 h after each biopsy, a prothrombin time and partial thromboplastin time was obtained from each subject. Mean values +/- the standard error of the mean were obtained using the independent samples T-test. Recombinant factor VIIa had a marked effect in transiently correcting the mean prothrombin time in these subjects allowing for a safe complication free percutaneous biopsy in this high-risk group. Recombinant factor VIIa could be used to obtain a clinically indicated liver biopsy in severely ill patients, who without this therapeutic agent, would either not be biopsied or, if biopsied, would require much longer hospitalization and the use of fresh-frozen plasma (with its risks of volume overload and infection).

A Retrospective Analysis of the Safety of Outpatient Percutaneous Liver Biopsy in Patients with Von Willebrand Disease

Purpose: Liver biopsy remains the gold standard for the diagnosis of chronic liver diseases. Outpatient percutaneous biopsy is generally safe with a mortality rate of 0.17% and hospitalization rate for bleeding of 3%. Von Willebrand Disease (VWD) is the most common inherited hematological disorder with a prevalence of 1–3% globally. There are 3 major types of VWD – type 1 (low levels of VW factor), type 2 (several qualitative abnormalities of VWF) and type 3 (extremely reduced or undetectable levels of VWF with low concentration of factor VIII). Type 1 is the mildest and most common form of VWD, while type 3 is the most serious, but very rare. Whether VWD increases the risk of bleeding in invasive procedures is not known. The purpose of this review is to determine the safety of outpatient percutaneous liver biopsies in patients with VWD. Methods: 120 patients who underwent outpatient percutaneous liver biopsies from 1997 to 2007 were included in the study. Demographics, PT/INR, platelet count, VW factor antigen, VW factor ristocetin cofactor, Factor VIII activity, and VW factor multimers were collected. Patients had not received salicylates, NSAIDs or anticoagulants for at least 5 days prior to biopsy. Exclusions included prior known coagulation diathesis, familial bleeding history, arteriovenous malformations, collagen vascular diseases and congestive heart failure. Results: Of the 120 patients biopsied, 66 (55%) had hepatitis C, 24 (20%) hepatitis B, 10 (8.3%) alcoholic hepatitis, 20 (16%) other diagnoses. Overall, 30 (25%) had minor local bleeding that resolved with pressure and 53 (48%) had biopsy site ecchymosis after 24 hours. Twelve (10%) patients were diagnosed with VW factor deficiency, of these 5 (41%), 7 (56%), and 0 had type 1, 2 and 3 respectively. No VWD patients had major bleeding that required transfusion, hospitalization or surgery but 9 (75%) had minor local bleeding and all had ecchymoses, which resolved spontaneously within a week. Conclusion: Patients with VWD types 1 and 2 without prior bleeding diathesis can undergo percutaneous liver biopsy without major bleeding. Minor bleeding may occur at a slightly higher rate. VWD type 1 and type 2 does not appear to be a contraindication to percutaneous liver biopsy. The safety of percutaneous biopsy in VWD type 3 patients is unknown. We concur with the AGA guideline that outpatient percutaneous liver biopsy is safe and non-threatening in the setting of concomitant minor inherited bleeding diathesis without prior history of excessive bleeding. Routine screening for undiagnosed VW syndrome is not recommended.

Diagnostic yield improvement by routine ultrasound-guided liver biopsy in viral chronic hepatitis

Ultrasound (US) assisted and US-guided percutaneous liver biopsy in patients affected by viral chronic hepatitis are considered to be safer than blind needle procedure. Some authors described diagnostic yield increasing by routine US-assisted needle biopsy but differences between diagnostic yield and safety of US-guided liver biopsy and US-assisted procedure have never been investigated. In our department we performed 176 US-guided and 181 US-assisted needle biopsies in 357 patients affected by viral chronic hepatitis. We used a Menghini modified 16 Gauche (G) automatic needle by using inter-costal approach. No major complication were observed.

Percutaneous Liver Biopsy Is Safe in Chronic Hepatitis C Patients With End-Stage Renal Disease

Liver biopsy is useful for staging fibrosis in chronic hepatitis C (CHC) patients with end-stage renal disease (ESRD) to determine renal transplant eligibility and to make CHC treatment decisions. There is concern about an increased risk associated with percutaneous liver biopsy (PCNB) in ESRD patients. We compared the safety of PCNB in CHC patients with and without ESRD. We reviewed PCNBs performed between 1996 and 2004 for technique, histology, and complications in 78 ESRD patients with CHC and in 241 control patients with CHC and no renal failure, randomly matched for age, sex, and race. Platelet counts, prothrombin, and partial thromboplastin times, but not bleeding times, were checked before biopsy. Deamino-8-D-arginine vasopressin was not given before the biopsy. The mean age of the patients was 50 years; 72% were male, 97% were African American, and 3% were Caucasian. The control group had a significantly higher proportion of patients with advanced fibrosis (P < .04). Only 1 patient with ESRD (1.3%) developed a moderate complication. Five controls (2.1%) developed complications, 3 of which were severe. Severe complications after PCNB are uncommon, and patients with ESRD and CHC are at no increased risk. Testing for bleeding time and the routine use of deamino-8-D-arginine vasopressin are not necessary before PCNB in patients with ESRD.

Klinischer Nutzen und diagnostische Bedeutung der Leberbiopsie bei chronisch erhöhten Leberwerten nicht viraler Genese

In the context of increasing non-invasive diagnostic techniques the purpose of the present study was to determine the clinical usefulness and the diagnostic value of percutaneous liver biopsy in patients with chronically elevated liver enzymes of non-viral origin. 100 patients from the outpatient clinic of the department of gastroenterology and hepatology who had a liver biopsy in the years 1996 to 1998 because of chronically elevated alanine-aminotransferase (ALT) and/or gamma-glutamyltransferase (gamma-GT) levels were included. Exclusion criteria were as follows: chronic hepatitis B or C infection, focal liver disease and clinical signs of hepatic decompensation. Retrospectively gained clinical data were independently evaluated by two experienced hepatologists. Initially, both examiners made a preliminary clinical diagnosis prior to knowing results from liver histology. With the results from liver histology both examiners were asked to make a final diagnosis. For each patient, the preliminary clinical diagnoses of both examiners were then correlated with the corresponding final diagnoses. Liver histology led in 71 % respectively 74 % of the patients to confirmation or specification of the clinical diagnosis. Liver biopsy was particularly helpful in differentiating non-decompensated liver cirrhosis, cryptogenic hepatitis, auto-immune hepatitis and biliary diseases. Despite improved non-invasive diagnostic tools including a broad spectrum of serologic tests liver biopsy is often indispensable for differentiating primary liver from biliary diseases and for the early detection of patients with liver cirrhosis.

Sampling Variability on Percutaneous Liver Biopsy in Patients with Chronic Hepatitis C Virus Infection

Background: Sampling variability on liver biopsy has been demonstrated in a variety of liver diseases. The objective of this study was to determine whether sampling variability exists on percutaneous liver biopsy in patients with chronic HCV infection. Methods: Two separate tissue samples were obtained from the right lobe of the liver, through a single skin puncture, in 29 patients (22 M, mean age 43.4 ± 8.1 years) with chronic HCV infection. The biopsies were assessed using a descriptive histological reporting system and Knodell's Histological Activity Index (HAI) and compared for differences in necroinflammatory activity (grade) and fibrosis (stage). Results: Thirteen (44.8%) patients had a difference of ≥1 grade between the 2 biopsies on the descriptive system and 13 differed by ≥1 stage. On the HAI, 20 (69.0%) patients had a difference of ≥2 in the necroinflammatory activity score and 10 (34.5%) had a difference of ≥4; whereas, 11 (38.0%) patients had a difference of ≥1 in the fibrosis score and 6 (20.7%) had a difference of ≥2. The mean difference between the two sets of biopsies was 2.4 ±2.1 (range 0–7) for the necroinflammatory activity and 0.6 ±0.9 (range 0–3) for fibrosis. Spearman's correlation coefficient (r) was moderate for both necroinflammatory activity (r = 0.53, P < 0.01) and fibrosis (r = 0.62, P < 0.0001). Conclusions: Sampling variability exists on percutaneous liver biopsy in patients with chronic HCV infection and should be taken into consideration when decisions regarding prognosis and therapy are made based on biopsy, and when defining histological response to antiviral regimens.

Acute sickle cell hepatopathy represents a potential contraindication for percutaneous liver biopsy

AbstractAfter several complications following percutaneous liver biopsy in patients with sickle cell disease, we reviewed our experience. We examined 14 patients with sickle cell disease who underwent a percutaneous liver biopsy. Clinicopathologic findings were correlated with outcome. Of 14 patients, 5 (36%) suffered serious hemorrhage; 4 died (80%; 28% of all patients). None of the 9 patients without biopsy complications was in an acute sickling crisis at the time of biopsy; 4 of 5 patients with complications were in acute sickling crisis. Of the 5 patients with complications, 4 underwent biopsy for an emergency indication. Chronic venous outflow obstruction, marked hepatic sequestration of erythrocytes, and sinusoidal dilatation were strongly associated with complications. Data obtained by biopsy in group 1 were not of substantial value in clinical management, in contrast to group 2 (8/9; 89%). Acute hepatic disease complicating sickle cell anemia represents a newly identified contraindication to percutaneous liver biopsy.

Retrospective audit of day-case percutaneous liver biopsy in patients with hepatitis B &amp; C requiring hospitalization

Retrospective audit of day-case percutaneous liver biopsy in patients with hepatitis B &amp; C requiring hospitalization

Percutaneous biopsy of liver tumors with color Doppler US guidance.

Percutaneous liver biopsy is a well-established procedure. Aim of this study was to investigate the usefulness of color Doppler ultrasound (US) for guiding percutaneous biopsy of liver tumors in patients at high risk of bleeding. Forty-seven patients with severe, uncorrectable coagulopathy (platelet count < 50 x 10(9)/L and/or prothrombin time ratio [normal/patient] < 50%) were submitted to percutaneous biopsy of focal liver lesions using a 21 G cutting needle. The procedure was guided by color Doppler US, avoiding the needle cross into any liver or tumor vessel. Biopsy material was adequate for pathological reading in 46/47 cases (97.9%). No major post-biopsy complication was observed. In particular, no case of hemoperitoneum was detected on US examinations performed 2 hours after biopsy. Minor complications (including one subcapsular hematoma) occurred in 4 patients (8.5%). Color Doppler US can safely guide percutaneous liver biopsy in patients at high-risk of bleeding.

Percutaneous Liver Biopsy in Patients with Large Bile Duct Obstruction

This study was undertaken to assess the risks and value of percutaneous needle biopsy of the liver by the Menghini method in patients with large bile duct obstruction. There were 125 such patients in whom 127 biopsies were attempted. In 30% of the patients the serum bilirubin exceeded 10 mg per 100 ml. Dilated bile ducts, shown by successful percutaneous cholangiography, were found in 38 patients. A major complication, biliary peritonitis which necessitated surgical intervention, was recorded in 1 patient and there were seven minor complications in other patients which were easily controlled by medical measures. There was no mortality. Liver biopsy failed in 2 patients. Histological changes compatible with large bile duct obstruction were found in 83% of the patients. Misleading histological appearances were seen in six biopsies. In 17 patients the initial opinion of the histopathologist was of particular value and altered the clinician's original diagnosis. Liver biopsy is of considerable diagnostic value in patients with large bile duct obstruction, and, in this series, the incidence of significant complications was low.