Utility and Safety of Transjugular Liver Biopsy in Children

Abstract

Transjugular liver biopsy (TJLB) is widely used in adults when percutaneous liver biopsy (PLB) is contraindicated. The authors evaluated the safety, efficacy and utility of TJLB in pediatric patients with contraindications to PLB. Twenty-three children and adolescents (13 male) underwent 24 (one patient had two separate biopsies) consecutive biopsies (TJLB) under general anaesthesia (18) or intravenous sedation (6). PLB was contraindicated because of elevated prothrombin time (PT)/international normalized ratio (INR) (˃ 15.5/1.5) in 19 (79.2%) and thrombocytopenia (< 60,000/dL) in 15 (62.5%) procedures. Derangement in both INR and platelet count were found in 12 (50%) cases. Significant ascites was present in 10 (41.7%) procedures. Technical success rate with adequate biopsy sample was 95.8% (23/24) with no major complications. A new diagnosis was established in 9 (37.5%) cases. Another 14 (58.34%) biopsies confirmed the initial diagnoses. Four cases also revealed additional information guiding overall management and prognosis. Thus, TJLB is a safe and useful procedure in children.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Sporea I, Popescu A, Sirli R. Why, who and how should perform liver biopsy in chronic liver disease. World J Gastroenterol. 2008;14(21):3396–402.

    Article  Google Scholar 

  2. 2.

    Furuya KN, Burrows PE, Phillips MJ, et al. Transjugular liver biopsy in children. Hepatology. 1992;15(6):1036–42.

    CAS  Article  Google Scholar 

  3. 3.

    Gamble P, Colapinto RF, Stronell RD, et al. Transjugular liver biopsy: a review of 461 biopsies. Radiology. 1985;157:589–93.

    CAS  Article  Google Scholar 

  4. 4.

    Boge M, Ocal O, Eldem G, et al. Transjugular liver biopsy in pediatric patients with uncorrectable coagulopathies. Acta Medica. 2016;5:93–8.

    Google Scholar 

  5. 5.

    Srivastava A, Prasad D, Panda I, et al. Transjugular versus percutaneous liver biopsy in children: indication, success, yield, and complications. J Pediatr Gastroenterol Nutr. 2020;70:417–22.

    CAS  Article  Google Scholar 

  6. 6.

    Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med. 2001;344:495–500.

    CAS  Article  Google Scholar 

  7. 7.

    Nagral A, Waravdekar G, Nisar P, et al. Transjugular liver biopsy- experience in fifty patients. Indian J Gastroenterol. 2003;22(5):173–5.

    PubMed  Google Scholar 

  8. 8.

    Papatheodoridis GV, Patch D, Watkinson A, et al. Transjugular liver biopsy in the 1990s: a 2 year audit. Aliment Pharmacol Ther. 1999;13:603–8.

    CAS  Article  Google Scholar 

  9. 9.

    Smith TP, Presson TL, Heneghan MA, et al. Transjugular biopsy of the liver in pediatric and adult patients using an 18- gauge automated core biopsy needle: a retrospective review of 410 consecutive procedures. Am J Roentgenol. 2003;180:167–72.

    Article  Google Scholar 

  10. 10.

    Sheryl T-S, Obi C, Kothary N, et al. Comparison of Transjugular liver biopsy and percutaneous liver biopsy with tract embolization in Pediatric patients. J Pediatric Gastro Nutrition. 2018;67:180–4.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Contributions

PM and RM conceived the study. PM, RM and KSM wrote the manuscript. SS reviewed the manuscript and edited it. SS will act as guarantor for this paper.

Corresponding author

Correspondence to Rohan Malik.

Ethics declarations

Ethical Clearance

Cleared by the Institutional Ethics Committee, AIIMS, New Delhi.

Conflict of Interest

None.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Maji, P., Malik, R., Madhusudhan, K.S. et al. Utility and Safety of Transjugular Liver Biopsy in Children. Indian J Pediatr (2021). https://doi.org/10.1007/s12098-020-03650-z

Download citation

Keywords

  • Liver biopsy
  • Coagulopathy
  • Ascites
  • Transjugular liver biopsy
  • Children