Elsharkawy, A.M.; Austin, A.S.; Ryder, S.D.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA35
Academic Journal
Introduction: Histological examination of liver tissue is the gold standard for diagnosing and staging liver disease. We assessed the safety, efficacy, and clinical impact of transjugular liver biopsy (TJBx) in a non-transplant centre. Methods: 180 consecutive biopsies were performed using an automated transjugular cutting biopsy needle with a maximum core length of 25 mm and diameter of 2.2 mm. Mean patient age was 54.2 ± 13.8 (17-89) of whom 114 were male. Results: Indications for TJBx were platelet count < 100 × 109/I (49%), INR > 1.4 (41%), bilirubin > 100 µmol/I (35%), tense ascites (23%) or other (17%). 44% had two or more indications. Minor transient complications occurred in 11 cases only (5 hypotension, 4 pain, 2 fever). Biopsy sample was adequate for histological diagnosis in 93%, inadequate in 4%, and technically unsuccessful in 2%. Mean biopsy size was 14.8 ± 0.6 (5-35) mm. Adequacy and length did not differ beh, veen cirrhotic and non-cirrhotic biopsies. In 63% of cases, alcoholic liver disease was the presumed diagnosis before biopsy. TJBx had a clinical impact in 78%; changed diagnosis in 38% (drug induced liver injury 11, haemachromatosis 8, normal liver 6, cryptogenic cirrhosis 5, other 39); and changed stage in 40%. The likelihood of a change in diagnosis was greater in the non-cirrhotic 21/64 compared with the cirrhotic 35/116 (Chi test; p = 0.001). In addition, a change in diagnosis was less common in those with a presumptive diagnosis of alcoholic liver disease 25/113 compared with those without 44/67 (Chi test; p < 0.001). Conclusions: Transjugular liver biopsy is a safe procedure in high risk patients in a non-transplant centre. It provides adequate tissue samples in the vast majority irrespective of the presence or absence of cirrhosis. It has a clinical impact in 78% leading to an unsuspected diagnosis in 38%.


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