Percutaneous liver biopsy in children: impact of ultrasonography and spring-loaded biopsy needles.
BACKGROUND
Percutaneous liver biopsy is a valued tool of pediatric hepatology. Recent advances in technology have incorporated spring-loaded biopsy needles and ultrasonography in percutaneous liver biopsy.


METHODS
To determine the frequency of complications after liver biopsy and whether variables such as needle selections (Jamshidi, Monopty, or ASAP) and ultrasound guidance could predict complications, medical records were retrospectively reviewed of all patients who underwent percutaneous liver biopsy during a 7-year period. Available data were collected from 123 patients who had undergone a total of 249 percutaneous liver biopsies. All patients with evidence of mild clotting abnormalities (8.83%) received platelets, cryoprecipitate, or fresh-frozen plasma.


RESULTS
There was a 6.83% incidence of overall complications, and a 2.4% incidence of major complications. The mortality rate was 0.4%. Ultrasound localization did not diminish the risk of bleeding during biopsy. There was no significant difference in the change of hematocrit between the aspiration (Jamshidi) and spring-loaded (Monopty) needles. However, in patients less than 5 years of age, the change of hematocrit was significantly higher (P < 0.05) with the 15- or 18-gauge ASAP needle (Microvasive, Quincy, MA, U.S.A.) than with either the Jamshidi (Allegience Healthcare, Columbia, MD, U.S.A.) or Monopty (Bard Technologies, Covington, GA, U.S.A.) needles.


CONCLUSIONS
Percutaneous liver biopsy is safe, using either aspiration or spring-loaded needles. Ultrasound guidance may not be helpful except in patients who underwent segmental liver transplantation.
Scheimann
A O
AO
Department of Pediatrics, Johns Hopkins Children's Center, Baltimore, Maryland 21287, USA.
Barrios
J M
JM
Al-Tawil
Y S
YS
Gray
K M
KM
Gilger
M A
MA
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001707:Biopsy, Needle / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001780:Blood Coagulation Tests; D002648:Child; D002675:Child, Preschool; D004869:Equipment Safety; D005260:Female; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology*; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D016031:Liver Transplantation; D008297:Male; D009339:Needles / Q000145:classification; D012189:Retrospective Studies; D012307:Risk Factors; D014463:Ultrasonography
D006454:Hemoglobins