Transjugular Liver Biopsy

Abstract

Although transjugular liver biopsy requires the availability of trained personnel, takes more time than percutaneous biopsy and is moderately expensive, it is a safe alternative technique for obtaining adequate liver tissue for diagnosis in special clinical situations. The usual indications for transjugular rather than percutaneous liver biopsy are (a) coagulation disorder (prothrombin time greater than 3 sec over control value and/or platelet count less than 60,000/cm3), (b) massive ascites and (c) desire to perform ancillary procedures, such as measurement of pressures or opacification of the hepatic veins and inferior vena cava. Less common indications for transjugular liver biopsy include failed percutaneous biopsy, massive obesity, small cirrhotic liver (increased risk and lower success rate) and suspected vascular tumor or peliosis hepatis. Results from several centers indicate that adequate or diagnostic liver tissue is obtained in 81% to 97% of cases. The typical length of the biopsy core ranges from 0.3 cm to 2.0 cm. Modification of the classic technique, particularly the adaptation of a Tru-Cut needle, shows promise in yielding longer cores of tissue with less fragmentation. Transjugular liver biopsy is performed with an acceptable complication rate that ranges 0% to 20%. The reported mortality of transjugular liver biopsy was 0 in three major centers and ranged from 0.1% to 0.5% in three other centers. Transjugular liver biopsy may be useful in obtaining diagnostic liver tissue not only in advanced chronic liver disease with coagulopathy, ascites or both, but also in patients with fulminant hepatic failure to better determine prognosis and the need for liver transplantation.

Transjugular liver biopsy: histological diagnosis success comparing the trucut to the modified aspiration Ross needle

“…In a review carried out by McAFEE et al (25) , an average of 3.5 triads (± 3.5 SD) is reported, but the type of needle employed is not specified. KARDACHE et al (20) reported eight or more portal triads.…”

“…However, excessive fragmentation of liver specimens was observed even after the change to a reversed bevel needle and the addition of an inner stylet (10,13,15,23) . A modified version of the percutaneous Vim-Silverman side-cutting needle -the trucut needle -has been proposed for TJLB with the aim of providing larger and less fragmented specimens (7,16,25) . An automated trucut needle, the Quick-Core needle system has also been proposed, and its success rate of histological diagnosis seems to be higher than the modified aspiration Ross needle in patients with suspicion of chronic liver diseases (2,9,12,18,19,20,27) .…”

The use of laparoscopic liver biopsies in pediatric patients with hepatic dysfunction following allogeneic hematopoietic stem cell transplantation

“…9,19,20 The transjugular approach offers other advantages as well, including the ability to perform imaging studies of the hepatic venous system and determining intrahepatic pressures. 9,12,21 While this procedure has been used to evaluate hepatic dysfunction in adult HSCT patients, studies in pediatric HSCT recipients are limited. Of the five studies reporting on the success of this approach in children, [22][23][24][25][26] only two included HSCT patients.…”

“…23,25 These studies concluded that the transjugular liver biopsies are safe and effective in the pediatric population, but this approach also has significant disadvantages including the need for highly skilled personnel, increased procedure time, and concerns relative to inadequate sample size for histologic examination. 12 Laparoscopy is a widely used diagnostic and therapeutic tool, and liver biopsy using this approach has proven to be an effective means for evaluating hepatic dysfunction in adult patients with hematologic malignancies. Iqbal et al 27 reported on a series of 29 adults who were immunocompromised, thrombocytopenic, and often neutropenic following intensive cytotoxic therapy with or without HSCT.…”

“…Transjugular liver biopsies are typically performed in patients with contraindications to the percutaneous approach. 7 Despite the reported safety and effectiveness of this approach in many large patient series, [8][9][10][11] the risk of hemorrhage can be as high as 20% 9,12 and the use of this approach in children can be technically challenging.…”