Postbiopsy Bleeding Research Articles

Hemoclipping for postpolypectomy and postbiopsy colonic bleeding

Background: Obtaining colonoscopic biopsies and polypectomy can result in hemorrhage. The most effective management of this complication has not been determined. The objective of this study was to evaluate the endoscopic hemoclip in postprocedural colonic bleeding. Methods: Among 9555 consecutive colonoscopies, cases of postprocedural colonic bleeding (postpolypectomy and postbiopsy) requiring treatment were retrospectively reviewed. Endoscopic hemoclipping was initially attempted in each case; the rate of hemostasis after hemoclipping, use of additional hemostatic methods, and clinical outcome (need for transfusion/hospitalization) were analyzed. Results: There were 72 cases of bleeding in which treatment was required (45 immediate postpolypectomy, 18 delayed postpolypectomy and 9 postbiopsy). Endoscopic hemostasis was achieved in all cases of immediate postpolypectomy and postbiopsy bleeding and in all but one of the cases with delayed postpolypectomy bleeding. A detachable snare was used in addition to hemoclips in 3 cases of delayed postpolypectomy bleeding. There were no episodes of recurrent bleeding, deaths or need for surgery related to bleeding. Conclusion: Early endoscopic management of postprocedural bleeding by hemoclipping provides hemostasis in the great majority of cases. (Gastrointest Endosc 2000;51:37-41.)

Safety of percutaneous biopsy of hepatocellular carcinoma with an 18 gauge automated needle

Objective: Accurate histological diagnosis and subtyping of hepatocellular carcinoma (hepatoma) is likely to be enhanced if a large biopsy tissue specimen is made available to the pathologist. However biopsy of this tumour can be dangerous, especially if the liver is cirrhotic and the lesion is superficial. This study evaluates the safety of an 18 gauge spring loaded side-cutting needle in the percutaneous biopsy of hepatoma in cirrhotic patients under ultrasonographic (US) guidance. Particular attention was paid to establishing the necessary length of needle track through interposing liver parenchyma to be certain of maximum safety. Materials and Methods: One hundred and thirty-nine consecutive biopsy procedures were performed on 129 hepatomas which belonged to 113 men and 12 women of average age 57 ± 15 years old (median 60, range 8 months-88 years). Ninety-six (69.1%) of these biopsies were performed in cirrhotic livers. The length of biopsy needle track traversing interposing liver parenchyma was less than 1 cm in two cases, 1 cm in 41 cases, between 1 and 2 cm in 46 cases and > 2 cm in 50 cases. The mean tumour size was 7.2 ± 4.5 cm (median 6.8 cm, range 0.7–25 cm). The average number of needle pass in each biopsy was 2.1 ± 0.8 times (median 2, range 1–5). Results: One hundred and twenty-six (90.6%) of the biopsy procedures were diagnostic of hepatoma. There were two cases of post-biopsy bleeding, both occurred in procedures with an interposing liver parenchymal track less than 1 cm in length. Conclusion: The biopsy technique described was found to be safe for diagnosing hepatoma in patients with or without liver cirrhosis provided that the length of interposing liver parenchymal track is not < 1 cm.

Thromboelastography for the prediction of bleeding after transplant renal biopsy.

The ability of prebiopsy coagulation assays to predict mild postbiopsy bleeding was evaluated in renal transplant patients undergoing renal allograft biopsy (N = 120). The coagulation assays studied included the bleeding time, prothrombin time, partial thromboplastin time, platelet count, and thromboelastograph (TEG). Coagulation results were defined as abnormal if they fell outside the established normal reference range. Bleeding was defined as a drop in the hematocrit equal to or more than 4 points 6 h after the procedure or ultrasound evidence of a new perirenal hematoma. Overall, 21% of patients showed evidence of mild bleeding. Of those who bled, 78% had normal results on all coagulation tests, indicating that most mild bleeding was not associated with coagulation abnormalities. Of the assays tested, only abnormal TEG:angle (P < 0.01) and TEG:k (P < 0.04) values were associated with an increased risk of bleeding. Bleeding times were not predictive of an increased risk of postbiopsy bleeding; five patients had abnormal bleeding times ranging from 10 to 20 min of whom only one bled. All prothrombin time, partial thromboplastin time, and platelet count abnormalities were mild (e.g., no prothrombin times longer than 15 s, no platelet counts below 129,000/microL); none of these assays predicted postbiopsy bleeding. Other clinical characteristics, including patient age, sex, serum creatinine, blood pressure (if less than 160/90 mm Hg), number of biopsy passes, or renal pathology, did not appear to influence bleeding after biopsy. It was concluded that most bleeding after transplant renal biopsy was not associated with coagulation abnormalities and that the TEG was the best assay for detecting mild coagulation abnormalities associated with an increased risk of bleeding.

CT-guided renal biopsy using a coaxial technique and an automated biopsy gun.

In this series, 35 patients with medical renal disease had renal biopsy guided by computed tomography (CT). Biopsies were done by a coaxial technique in which a thin-walled 16 guage guide needle is placed adjacent to the renal capsule of the lower pole. An 18 gauge cutting needle is then placed through the guide needle, and multiple samples (2 to 4) are obtained with an automated biopsy gun. Adequacy of specimens is immediately checked in the CT suite using low-power microscopy. Specimens are submitted for light, electron, and immunofluorescence microscopy. Adequate tissue for definite diagnosis was obtained in 33 of the 35 patients (94%). One patient had moderate postbiopsy bleeding and was hospitalized. There were no major complications. CT-guided renal biopsy using a coaxial technique and automated biopsy gun is an effective means of obtaining tissue for the evaluation of medical renal disease.

Diagnostic laparoscopy of the liver and peritoneum using conscious sedation.

Laparoscopic study of the liver is now common in many U.S. medical centers. With proper preparation, the procedure can be performed safely in the endoscopy suite using conscious sedation. Multiple sites in the liver can be biopsied in a directed and rapid sequence. Postbiopsy bleeding can be detected early and stopped effectively should it occur. Restrictions after the procedure are similar to those for other outpatient surgical procedures along with the typical post-liver biopsy instructions. A successful laparoscopy requires careful nursing evaluation, monitoring, and assistance. In this article, the authors discuss the practical aspects of diagnostic laparoscopy performed in the endoscopy suite, the nurse's role during and after the procedure, and management of the instruments.

Liver biopsy bleeding time: an unpredictable event.

The aim of this study was to observe the correlation between liver biopsy bleeding time, prothrombin time ratio and platelet count. The subjects were 51 consecutive patients referred for laparoscopic liver biopsy. The intervention was laparoscopy under local anaesthetic and liver biopsy with observation of post biopsy bleeding time. No correlation was found between observed liver biopsy bleeding time and platelet count or prothrombin time ratio. Thus, mild to moderate coagulopathy does not appear to be associated with prolonged bleeding following liver biopsy. Equally, normality of these coagulation studies does not indicate an absence of risk for post liver biopsy bleeding.

Lower rates of postbiopsy bleeding: Needle vs. technique

Lower rates of postbiopsy bleeding: Needle vs. technique

The use of two new coagulation probes for control of hemorrhage in laparoscopic liver biopsy

Two new prototype probes, BICAP and Heater, were assessed to determine their effectiveness in controlling post-biopsy bleeding during laparoscopy. A total of 88 patients with a wide spectrum of liver diseases were studied. Both probes were equally effective in stopping bleeding in all patients. We recommend the use of either of these devices in controlling post-biopsy bleeding.

9 - Transjugular Biopsy of the Liver

Percutaneous liver biopsy is the procedure of choice for most patients because of its simplicity and the high percentage of adequate biopsies obtained. It is a bedside procedure that does not require specialized equipment or the services of a highly trained angiographer. Nevertheless, complications are not uncommon unless strict contraindications are observed. It is usually recommended that patients be excluded who present with ascites, a prothrombin time less than 50%, a partial thromboplastin time greater than 10 s, or a platelet count less than 50 000. Mahal et al (1979) cite lack of attention to the contraindications as the most important factor in 22 bleeding episodes which occurred following 3800 percutaneous biopsies (0.7%). It is these contraindications that are the main indication for transjugular biopsy. Despite the highly selective nature of the patients who have undergone transjugular biopsy, the frequency of post-biopsy bleeding is only 0.35% and of death 0.13% (Table 1). These figures include the earliest experiences with this technique and can be expected to improve with increased experience and the development of new instruments that make the procedure safer and easier. Transjugular liver biopsy should be an essential procedure in every hospital that is involved in treating patients with liver disease. Unfortunately, although Lebrec et al (1982) estimated that approximately 30% of patients are rejected for percutaneous biopsy because of the presence of contraindications, relatively few centres have adopted this technique. This may be in part due to the reluctance of clinicians to subject their patients to a procedure they perceive as stressful, although a study by Poynard and Lebrec (1982) showed patients rated transjugular biopsy as less painful and inconvenient than percutaneous biopsy.

A Comparison of Endometrial Histology with Simultaneous Plasma Progesterone Determinations in Infertile Women

A retrospective analysis of 238 endometrial biopsies and simultaneous plasma progesterone determinations performed during the course of infertility evaluations is presented. The data suggest a high (93%) correlation between the two procedures for the detection of ovulation. Endometrial abnormalities were detected in 5% of the biopsies. Shortening of the cycle was noted in 36% of the patients, while only 3% demonstrated a longer cycle. Simultaneous measurement of plasma progesterone levels in association with the endometrial biopsy is believed to better document corpus luteum defects. One should be aware of the frequent occurrence of a shortened cycle on the basis of postbiopsy bleeding. Basal body temperature graphs should be utilized prior to biopsy in patients with a history of irregular menstrual cycles.

Needle biopsy of the kidney.

To the Editor.— Drs. Immergut and Plotkin (211:827, 1970) are to be commended for their courage and candor in reporting their renal biopsy complication. I agree with their conclusion that renal arteriography should be done promptly when faced with postbiopsy bleeding. However, I must take issue with their statement that renal biopsy under fluoroscopic visualization after infusion pyelography is a blind procedure. The advantage of the fluoroscopic pyelographic technique is that the biopsy needle may be easily guided to a point just within the lateral margin of the lower pole of the kidney. This extra precaution avoids large blood vessels and calyces and minimizes the possibility of trauma to the vascular supply or collecting system. Reference to Fig 2 in the report illustrates this last point. The kidney is well outlined by dye but the site of biopsy is almost closer to the hilus than to the peripheral margin,

MASSIVE BLEEDING TEN DAYS AFTER RENAL BIOPSY.

Renal biopsy is a common procedure in most large hospitals. The safety and efficacy of this procedure have been well established, 1 and complications, when they occur, are usually noted in the immediate postbiopsy period. 2 This report concerns fatal, postbiopsy bleeding, occurring ten days after a percutaneous renal biopsy. Report of Case A 47-year-old man was admitted to the Philadelphia General Hospital on Feb 22, 1964, because of progressive weakness, lethargy, and neuropathy involving the left thigh of six months' duration. He had been hypertensive for more than six years. Otherwise, his past medical history was unremarkable. Physical examination on admission revealed a chronically ill Negro man in no acute distress. The blood pressure was 190/110 and the pulse 64/min. His optic fundi showed mild hypertensive changes. He had cardiomegaly and marked hyperesthesia over the lateral aspect of the left thigh. Initial Laboratory Findings. —Hemoglobin was 13.7 gm per