title: Transjugular liver biopsy--indications, adequacy, quality of specimens, and complications--a systematic review.
abstract: Transjugular liver biopsy (TJLB) is considered an inferior biopsy, used when percutaneous liver biopsy (PLB) is contraindicated. According to recent literature, specimens with 6 complete portal tracts (CPTs) are needed for histological diagnosis of chronic liver disease but 11 CPTs to reliably stage and grade. Mean CPT number in PLB series is 7.5; more passes increase complications. Sixty-four series reporting 7649 TJLBs were evaluated for quality of specimen and safety. Major indications were coagulation disorders and/or ascites. Success rate was 96.8%. Fragmentation rate was 34.3%, not correlating with length or diagnostic adequacy. With a mean of 2.7 passes, mean CPT number was 6.8. Histological diagnosis was achieved in 96.1% of TJLBs, correlating with length (p=0.007) and CPT number (p=0.04). Tru-Cut specimens had a mean CPT number of 7.5 and, compared to Menghini specimens, were longer (p<0.008), less fragmented (p<0.001) and more diagnostic (p<0.001). Thinner needles (>16-G) provided significantly longer and less fragmented specimens. Minor and major complication rates were 6.5% and 0.56%, respectively, and increased in children, but not with additional passes. In adults, mortality was 0.09% (haemorrhage 0.06%; ventricular arrhythmia 0.03%). TJLB is safe, providing specimens qualitatively comparable to PLB, and may improve further using > or = 18-G Tru-Cut needle and >3 passes.
authors.affiliation: The Sheila Sherlock Hepatobiliary Pancreatic and Liver Transplantation Unit, Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG, UK.
authors.forename: George
authors.initials: G
authors.lastname: Kalambokis
authors.forename: Pinelopi
authors.initials: P
authors.lastname: Manousou
authors.forename: Shusang
authors.initials: S
authors.lastname: Vibhakorn
authors.forename: Laura
authors.initials: L
authors.lastname: Marelli
authors.forename: Evangelos
authors.initials: E
authors.lastname: Cholongitas
authors.forename: Marco
authors.initials: M
authors.lastname: Senzolo
authors.forename: David
authors.initials: D
authors.lastname: Patch
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Burroughs
mesh_terms: D001707:Biopsy, Needle / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D006801:Humans; D007601:Jugular Veins; D008099:Liver / Q000473:pathology*