Percutaneous liver biopsies guided with ultrasonography: a case series (original) (raw)
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The role of ultrasonography and automatic-needle biopsy in outpatient percutaneous liver biopsy
Hepatology, 1996
Percutaneous liver biopsies are frequently performed opsy is low, but discomfort is common and complications to establish the diagnosis, assess prognosis, and monirequire hospitalization in approximately 4% of patients. tor therapy for various liver diseases. Although the rate The optimal method of performing these biopsies is unof serious complications is õ1%, the rate of complicaknown. The goal of our study was to determine whether tions requiring hospitalization is around 4% and failure the use of ultrasonography in the biopsy room immedito obtain liver tissue occurs in approximately 2% of ately prior to or during the procedure would lessen the patients. 1-4 It has been assumed by many that ultrarisk of complications and to compare the safety and effisound enhances the safety of liver biopsy, but few concacy in obtaining tissue by use of a Trucut needle versus trolled trials of ultrasound versus blinded biopsies in an automatic biopsy needle. Between 1992 and 1994, 836 the absence of suspected masses have been published. 5 patients were entered into a randomized study (489 in Rochester, MN; 347 in Barcelona, Spain). Patients were If ultrasound prevented complications of liver biopsy randomized immediately prior to liver biopsy into four while at the same time increasing the yield of diagnosgroups: Trucut needle, or automatic biopsy needle, and tic liver tissue, the additional expense might be justiwith or without ultrasonography. Fisher's Exact Test fied. and a logistic regression model were also used to assess The complication rates with a cutting-type needle the effect of needle and ultrasonography on the odds for (Trucut or Silverman) and an aspiration-type needle complications. The four biopsy groups were well-(Jamshidi or Menghini) still are debated, 1,3,6 but probamatched at entry with respect to age, sex, underlying bly are about the same. However, the yield of liver liver disease, hemoglobin, prothrombin time, and platetissue from fibrotic livers is thought to be higher with let count. The use of ultrasound was associated with a the cutting-type needle. 7 An automatic biopsy needle decreased rate of hospitalization for pain, hypotension, or bleeding (2 vs. 9, P õ .05). No difference in safety was (Microvasive, Boston, MA) has been developed that thefound between the two types of needles. The number of oretically possesses the advantages of a cutting-type passes needed to obtain specimens was similar for all needle without the need for manual manipulation. 8 four groups. The average length of the specimen was Formal studies regarding the adequacy of the tissue slightly greater with ultrasonographic-guided biopsies obtained with this automatic biopsy needle have not (1.7 mm vs. 1.6 mm, P õ .05) and with biopsies obtained been performed. using the automatic biopsy needle when compared with Late complications occurring days to weeks after the Trucut needle (1.7 mm vs. 1.5 mm, P õ .05), but this liver biopsy have not been prospectively evaluated. Perdid not seem to be clinically important. The addition of sonal experience as well as reports from the literature ultrasonography reduces complications in patients unindicate that this may be a problem that has not been dergoing percutaneous liver biopsy. The type of needle appears to offer little difference in safety or yield of diag-adequately addressed. 9,10 In this study, we sought to nostic tissue. The use of ultrasonography for guidance determine whether the use of ultrasonography at the of percutaneous liver biopsy will lead to a lower rate of time of biopsy would improve the safety or diagnostic complications. The value of this benefit must be weighed yield, whether an automatic biopsy needle held any against the added cost of ultrasonographic guidance. advantage over the traditional Trucut needle, and
Percutaneous liver biopsy using an ultrasound-guided subcostal route
Digestive diseases and sciences, 2001
Percutaneous biopsy is considered one of the most important diagnostic tools to evaluate diffuse liver diseases. The introduction and widespread diffusion of ultrasounds in medical practice has improved percutaneous bioptic technique, while reducing postoperative complications. Although ultrasonography has become almost ubiquitous in prebiopsy investigation, only one third of biopsies are performed under ultrasound control. Moreover, the one-day procedure, reported in several studies to be safe and cost effective, accounted for only 4% of biopsies done. We report our experience of 142 percutaneous US-guided biopsies performed on 140 patients affected by chronic diffuse liver disease over a four-year period. Liver biopsies were performed under US guidance at the patient's bed using an anterior subcostal route. We evaluated postoperative pain, modifications of blood pressure and red cell count, hospital stay, morbidity and mortality rates, and adequacy of specimens for histologic ...
Ultrasound-assisted percutaneous liver biopsy performed by a physician assistant
The American journal of gastroenterology, 2002
Percutaneous liver biopsy is an essential diagnostic tool utilized in the management of patients with liver disease. This procedure is generally performed by a physician and has a small but well-defined complication rate. We report on the complication rate and efficiency of ultrasound-assisted percutaneous liver biopsy performed by an experienced physician assistant. One thousand eighty-six consecutive outpatient liver biopsies (847 hepatic allografts and 239 native livers) were performed at a single center by a physician assistant between June, 1996 and June, 2000. Patients with hepatic mass lesions, unusual hepatic anatomy, and uncorrectable coagulopathy (international normalized ratio > 1.7, platelet count < 50 x 10(9)/L) were excluded. Bedside ultrasonography was used to determine the optimal site for the liver biopsy. Liver biopsies were performed with a 15-gauge Jamshidi aspiration biopsy needle. Patients were observed for 3 h after biopsy, followed by dismissal with sub...
Percutaneous Liver Biopsy in Children: Impact of Ultrasonography and Spring-Loaded Biopsy Needles
Journal of Pediatric Gastroenterology and Nutrition, 2000
Background: Percutaneous liver biopsy is a valued tool of pediatric hepatology. Recent advances in technology have incorporated spring-loaded biopsy needles and ultrasonography in percutaneous liver biopsy. Methods: To determine the frequency of complications after liver biopsy and whether variables such as needle selections (Jamshidi, Monopty, or ASAP) and ultrasound guidance could predict complications, medical records were retrospectively reviewed of all patients who underwent percutaneous liver biopsy during a 7-year period. Available data were collected from 123 patients who had undergone a total of 249 percutaneous liver biopsies. All patients with evidence of mild clotting abnormalities (8.83%) received platelets, cryoprecipitate, or fresh-frozen plasma. Results: There was a 6.83% incidence of overall complications , and a 2.4% incidence of major complications. The mortality rate was 0.4%. Ultrasound localization did not diminish the risk of bleeding during biopsy. There was no significant difference in the change of hematocrit between the aspiration (Jamshidi) and spring-loaded (Monopty) needles. However, in patients less than 5 years of age, the change of hematocrit was significantly higher (P < 0.05) with the 15-or 18-gauge ASAP needle (Microvasive, Quincy, MA, U.S.A.) than with either the Jamshidi (Allegience Healthcare, Columbia, MD, U.S.A.) or Monopty (Bard Technologies, Covington, GA, U.S.A.) needles. Conclusion: Percutaneous liver biopsy is safe, using either aspiration or spring-loaded needles. Ultrasound guidance may not be helpful except in patients who underwent segmental liver transplantation.
Percutaneous Liver Needle Biopsy Methods Can Be Safe and Effective in Patients with Viral Hepatitis
Viral Hepatit Dergisi
Objectives: The aims of this study were to evaluate the biopsy methods used in terms of safety, and effectiveness as well as incidence, and severity of complications. Materials and Methods: This study was conducted as a prospective, observational study with the participation of five centers in Turkey. Any patient complaints and/or complications were also recorded. The patients' pain severity was determined by an established scoring method. Results: This research included 221 chronic hepatitis patients and 12 physicians. With regard to the biopsies, 71.9% were ultrasoundguided and 28.1% were blind biopsies. 71% of patients had complaints (mostly pain) and 19.9% developed complications; however, no mortality occurred. It was observed that patient's complaints were significantly correlated with the physician's age, level of biopsy experience, and number of biopsies performed yearly. It was determined that the biopsy method was not affective factor in terms of the development of severe pain after biopsy. The use of a 16G biopsy needle was found to increase the probability of severe pain occurrence by about eight times. Conclusion: Severe pain was not affected by the biopsy method or patient-specific factors, and was a result of the size of the biopsy needle used and the characteristics of the practitioner.
Abdominal Imaging, 2008
Background: We retrospectively evaluated the value of the combination of ultrasonographic guidance for jugular vein puncture and an automated biopsy device for transjugular liver biopsy. Methods: Transjugular liver biopsy was performed with ultrasonographic guidance for right internal jugular vein puncture and an automated device for hepatic tissue sampling (Quick-Core Ò ) in 200 consecutive patients in whom percutaneous transhepatic biopsy was contraindicated. Histopathologic specimens were reviewed for adequacy and complications related to the procedure were analyzed. Results: Biopsies were technically successful in 198 of 200 (99%) patients. The two cases of technical failure were due to an acute angle between right hepatic vein and inferior vena cava (1%). Adequate gross hepatic tissue specimens (mean length, 11. 0 mm ± 5.3; range, 5.0-20.0 mm) were obtained in 198 (99%) patients, allowing definitive histological diagnosis in 196 of 198 patients, for an overall success rate of 98%. Neither cases of inadvertent injury of the carotid artery nor life-threatening intraperitoneal bleeding were observed. Minor complications were noted in 24/200 (12%) patients. Conclusion: The combination of ultrasonographic guidance for jugular vein puncture and an automated biopsy device for tissue sampling is recommended for transjugular liver biopsy as it results in a safe, well-tolerated, and efficient technique.
Practice and complications of liver biopsy
Digestive Diseases and Sciences, 1993
Studies on the complication rate of liver biopsy have hitherto been conducted in referral hospital centers. They are therefore not representative for general practice where liver biopsy is performed by specialists and nonspecialists. In a postal nationwide survey, we approached all gastroenterologists and hospital internists to assess the complication rate and practice (setting, needle type, use of ultrasonography) of percutaneous liver biopsy performed in 1989 in Switzerland for diffuse liver disease. Two hundred eighty questionnaires were mailed and 252 were returned (response rate 90. 0%) 165 respondents (65.5%) performed 3501 biopsies while 87 respondents (34. 5%) did not practice liver biopsy; 67. 7% of biopsies were executed blindly and 32.3% were guided. Eight nonfatal and three fatal complications occurred. Hemorrhage was the most frequent complication (five cases) and was responsible for all three fatal outcomes. The overall complication rate was 0.31%, being distinctly lower in the group of gastroenterologists (0.11%) as compared to the group of internists (0. 55%; P = O. 031). The complication rate was 1.68% in the group of internists performing fewer than 12 biopsies pc:'year, while there was no complication in the group of internists performing more than 50 biopsies per year (P = O. 036). Complications were not related to the needle diameter or to the absence of ultrasonography before biopsy. In conclusion, this representative survey in Switzerland shows that the complication rate of liver biopsy is mainly related to the experience and training of the operator.