[The applicability and diagnostic effectiveness of transjugular liver biopsy].
BACKGROUND
The aim of this study was to evaluate the applicability, the diagnostic profitability and the incidence of complications associated with tranjugular liver biopsy associated with the measurement of the hepatic venous pressure gradient (HVPG).


METHODS
The clinical histories of 829 consecutive patients in whom transjugular liver biopsy was performed from 1982 to 1993 were reviewed. The diagnostic value of the sample obtained was evaluated in all the patients and the HVPG determined. Moreover, the size of the greatest fragment obtained during biopsy was also determined.


RESULTS
Material for histologic study was obtained in 95% of the cases. In 70% the biopsy was diagnostic, in 11% it provided data contributing to diagnosis and in 19% it was not useful. Potentially severe complications were presented in 0.8% of cases being fatal in one (0.1%). The obtention of a fragment of small size was significantly associated with the presence of disease with marked fibrosis and high HVPG. A HVPG > 10 mmHg in patients with a suspicion of liver disease had a sensibility of 92% and a specificity of 63% for the diagnosis of hepatic cirrhosis. In 83% of patients with a GPVH > 10 mmHg in whom the biopsy was not useful, the diagnosis of hepatic cirrhosis was performed by other methods.


CONCLUSIONS
Transjugular biopsy in a safe, effective diagnostic method in patients with severe coagulation disorders. The appearance of the material obtained and the HVPG provide useful information for diagnosis although the biopsy is not diagnostic.
Trejo
R
R
Hospital Clínic i Provincial, Departamento de Medicina, Universidad de Barcelona.
Alvarez
W
W
García-Pagán
J C
JC
Feu
F
F
Escorsell
A
A
Bruguera
M
M
Bosch
J
J
Rodés
J
J
D001707:Biopsy, Needle / Q000009:adverse effects / Q000379:methods; D006503:Hepatic Veins; D006801:Humans; D007601:Jugular Veins; D008107:Liver Diseases / Q000473:pathology*; D012306:Risk; D012680:Sensitivity and Specificity; D014690:Venous Pressure