CO2 portography-investigation of choice in portal vein assessment?

Patch, David; Tibballs, Jonathan; Dodge, G.; Papatheodoridis, George V.; Goulis, Y; Watkinson, A.; Burroughs, AK

doi:10.1016/s0168-8278(98)80780-0

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“…The procedure is not only used when impaired haemostasis is present but also when there is gross ascites or measurement of hepatic venous pressures is needed 8 . In addition, we and others use carbon dioxide for retrograde visualization of the portal vein via the hepatic vein 18 , . 19 However, the diagnostic adequacy of specimens from TJLB has been a concern, particularly in cirrhosis, because of relatively small liver specimens compared to those obtained by the percutaneous route, 5 , 14 , 20 while the clinical impact of performing the biopsy has been questioned in some cases.…”

Section: Introductionmentioning

confidence: 99%

“…8 In addition, we and others use carbon dioxide for retrograde visualization of the portal vein via the hepatic vein. 18,19 However, the diagnostic adequacy of specimens from TJLB has been a concern, particularly in cirrhosis, because of relatively small liver SUMMARY Background: In view of the changing nature of transjugular liver biopsy, we performed an audit of the safety, adequacy and clinical impact of such biopsies in our centre over a 2-year period from 1995 to 1997. Methods: One hundred and ®fty-seven transjugular biopsies were carried out in 145 patients, with prothrombin time >5 s over control and/or platelet count <50´10 9 /L and/or gross ascites.…”

Section: Introductionmentioning

confidence: 99%

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Transjugular liver biopsy in the 1990s: a 2‐year audit

Papatheodoridis¹,

Patch²,

Watkinson

et al. 1999

Aliment Pharmacol Ther

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Background : In view of the changing nature of transjugular liver biopsy, we performed an audit of the safety, adequacy and clinical impact of such biopsies in our centre over a 2‐year period from 1995 to 1997. Methods : One hundred and fifty‐seven transjugular biopsies were carried out in 145 patients, with prothrombin time >5 s over control and/or platelet count <50 × 109/L and/or gross ascites. Results : Major complications were two (1.3%) capsular perforations, which were easily plugged with coils without sequelae. Biopsy sample was adequate for histological diagnosis in 90%, inadequate in 6% and technically unsuccessful in 4% of cases. Mean biopsy size was 14.8 ± 7.7 (1–51) mm. Adequacy did not differ between cases with and without cirrhosis. Transjugular biopsy had a clinical impact (specific diagnosis or influence on patient’s management) in 50% of acute liver disease, 62% of chronic liver disease and 87% of transplant patients (P < 0.001). In chronic liver disease, it had a significantly greater clinical impact in cases trying to establish the stage rather than diagnosis (84% vs. 35%, P < 0.001). Conclusions : Transjugular liver biopsy is a safe procedure for high‐risk patients providing an adequate liver sample even in cirrhosis. It has a clinical impact in more than 80% of transplant patients and for staging chronic liver disease, but in only 50% (acute) or 35% (chronic) of liver disease when a diagnosis is sought.

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