Transjugular liver biopsy: A review of 77 biopsies using a spring-propelled cutting needle (biopsy gun)

Abstract

Seventy-seven transjugular liver biopsies were performed with a coaxial, spring-loaded, 18-gauge cutting needle, the Biopty gun (Bard Biopsy System, Covington, GA, USA) on consecutive patients between July 1993 and February 1995. Fifty men and 27 women were included in the study; the mean age was 45 years (range 15-69 years). The average number of punctures per patient was 5.2, with a range of 2-9, yielding an average of 4.8 samples per patient (range 1-7). The length of the samples varied from 10 to 22 mm with a constant diameter of 1 mm. The mean time required to complete the procedure was 48 min (43-52 min). Histological diagnoses were obtained in 74 of 77 patients (96%), with non-diagnostic specimens attributed to excessive fragmentation (3 cases). Complications occurred in 10 patients (puncture site hematoma, carotid artery puncture, abdominal pain, vasovagal reaction, hepatic capsule perforation, and hemobilia). The latter two complications were self-limited. In our experience this transjugular hepatic biopsy method is promising for performing biopsies in patients with chronic liver disease, due to its high success rate and low morbidity rate.

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

“…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) .…”

Transjugular Core Liver Biopsy with a 19-Gauge Spring-Loaded Cutting Needle

“…The risk of TJLBx is primarily related to intraperitoneal hemorrhage, which occurred in 0.35% of the 2271 cases reviewed by Colapinto [1]. Recent studies using cutting needles report complications rates ranging from 2% to 20% as reviewed by Gorriz et al [2]. Their study reported a complication rate of 13.4% which included all (minor and major) complications.…”

“…Failure to obtain a diagnosis in our nondiagnostic specimens was not due to fragmentation. Gorriz et al [2] had three cases that were non-diagnostic because of excessive fragmentation when using an 18-gauge biopsy gun.…”

“…The 18-gauge biopsy gun used by Gorriz et al [2] averaged 5.2 passes per patient. Little et al [3], using the same Quick-Core system as we did, averaged 2.7 passes per patient in their series of 43 patients.…”

Transcaval Biopsy of Retroperitoneal Fibrosis

“…In large series the Tru-cuttype liver biopsy systems have demonstrated a higher success rate than modified transseptal needles while maintaining the low complication rate of the transvenous access. Adequate specimens were obtained even in cirrhotic livers [10,11]. In the patient described, the right femoral route was chosen as this access seemed more convenient because of marked obesity.…”