Transjugular biopsy of the liver in pediatric and adult patients using an 18-gauge automated core biopsy needle: A retrospective review of 410 consecutive procedures

OBJECTIVE. The aim of our study was to evaluate the safety and efficacy of transjugular biopsy of the liver in a large population of patients using an 18-gauge automated core biopsy needle. MATERIALS AND METHODS. A total of 371 patients underwent 410 attempted transjugular biopsies of the liver during an 80-month period. Data collected included the retrospective review of patients' computerized medical records, clinical charts, and nursing documents. Patient demographic data, indications for liver biopsy, laboratory findings of coagulation values, procedural data including number of needle passes performed, and histologic description of the specimens were noted. Indications varied and included traditional contraindications to the percutancous approach such as coagulopathy (53%) and ascites (29%). In one patient, the hepatic veins could not be catheterized because of angulation with the inferior vena cava, and in one patient, biopsy was performed using the femoral route because of occlusion of the jugular vein. All patients were followed up for a minimum of 24 hr after the procedure to determine complications. RESULTS. The mean number of needle passes per procedure was 3.4 (range, 0-18). Hepatic tissue was obtained in 409 procedures via the venous route (408 transjugular and one transfemoral), and a tissue diagnosis was achieved in 403 (98%). The six tissue samples were nondiagnostic because they were too small (n = 3) or too fragmented (n = 1) or because they did not contain hepatic tissue (n = 2). Ten complications (2.4%) occurred, including three intraperitoneal hemorrhages that resulted in one death. CONCLUSION. Transjugular biopsy of the liver using an automatic core biopsy needle is safe and produces adequate tissue specimens in a high percentage of patients.