Percutaneous Liver Biopsy Practice Patterns Among Pediatric Gastroenterologists in North America: Results of A Web-Based Survey: 105

Percutaneous liver biopsy (PLB) practices vary widely among pediatric gastroenterologists (GIs).

Aim:

To document PLB practices among pediatric GIs in North America.

Methods:

699 NASPGHAN members were invited by email to participate in a web-based survey. Queries about practice preferences used 5-pt Likert scales (1 = not at all, 5 = very important). Results were tabulated, and variables were analyzed by χ².

Results:

474 invitations were viewed and 308 (65%) surveys completed. 62% of all respondents reported practicing >10 yr, and 70% at academic centers. 59% described themselves as practicing GI and hepatology vs. 5% hepatology exclusively. 36% of all respondents perform no PLB, 58% ≤5 PLBs/mos, and 6% >5 PLBs/mos. Among those who do not perform PLB, 65% refer to interventional radiologists (IR), with medical indications, patient safety, and desire for real-time ultrasound (US) reasons for referral with mean ratings >4. Among those who perform PLBs, Bard-Monopty (39%) and Jamshidi needles (34%) are preferred devices. 44% observe patients for up to 8 hrs post-PLB while 56% admit overnight. In the same group, 36% report always using US assistance vs. 20% who never do. Among those who use US, patient safety, unusual anatomy, and inability to palpate/percuss liver margins are factors that scored >4. GIs who do not use US gave mean scores of ≤2 (1 = totally agree, 5 = totally disagree) for no proof of necessity and no cost benefit. We found no differences between academic vs. non, general GI vs. hepatology, or practice experience ≤10 vs. >10 yr groups regarding preference for routine use of US, PLB device, or overnight observation. Non-academic practitioners are more likely to use US routinely (34/69 vs. 49/160, p = 0.01). General pediatric GIs are more likely to refer to IR (73/292 vs. 0/16, p = 0.008).

Discussion:

Significant variation in PLB practice exists among pediatric GIs in North America. Further health services research may be useful to understand this variation and determine best practices.