Blind and ultrasound-guided percutaneous liver biopsy in children

Background. Percutaneous biopsy of the liver is the most commonly used procedure to obtain tissue for histopathological assessment of liver disease. Although, intuitively, image-guided liver biopsy might be expected to reduce the risk of bleeding, haematoma caused by a penetrating injury of a branch of the hepatic artery or portal vein, and puncture of the gallbladder, no trial has been large enough to show reduced mortality or morbidity with US guidance, and the mechanisms by which the use of US can reduce the risk of bleeding remain speculative. Objective. To compare the mortality and morbidity of blind liver biopsy with that of US-guided liver biopsy. Materials and methods. A retrospective review of our experience of 140 procedures over a 16-month period. Results. In the blind group, biopsy was unsuccessful in ten children (95% CL 7.3-25.4); no tissue was obtained in eight children and an inadequate sample was obtained in two. Three children (95% CL 9.2-14.7) suffered significant haemorrhage (indicated by a drop in haemoglobin of >20 g/l) with intrahepatic (n=1) and subcapsular (n=2) haematomas detectable by US after biopsy. An adequate sample was obtained in all children in the US-guided group. There were no complications requiring treatment in either group. Conclusions. Our results showed a significant difference in the complication rate between liver biopsy undertaken with US guidance and liver biopsy performed blind (P=0.002).