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Effect of Operator Experience and Frequency of Procedure Performance on Complication Rate After Ultrasound-Guided Percutaneous Liver Biopsies

Westheim, Birgitte H.*; Aagenæs, Ingegerd; Østensen, Anniken B.; Sanengen, Truls; Almaas, Runar*

Journal of Pediatric Gastroenterology and Nutrition: November 2013 - Volume 57 - Issue 5 - p 638–643
doi: 10.1097/MPG.0b013e3182a0c7a5
Original Articles: Hepatology and Nutrition

Objective: The aim of the present study was to assess whether the complication rate after ultrasound-guided percutaneous liver biopsies in children is affected by how frequently the procedure is performed by the operator.

Methods: Medical charts and ultrasound descriptions of 311 ultrasound-guided percutaneous liver biopsy procedures performed by 18 radiologists at a single center from 2000 to 2011 were reviewed. Postbiopsy ultrasound the following day was performed after 97% of the procedures.

Results: There were no differences in the procedure-associated rate of major bleeding incidents (2.2% vs 0.8%, P = 0.38), minor bleeding incidents (15.2% vs 10.2%, P = 0.31), or abdominal pain (13.0% vs 10.6%, P = 0.61) among operators who performed ≤10 procedures and those who performed >10 procedures during the study period. A higher rate of minor bleeding incidents were recorded after liver biopsy when operators had performed <10 biopsies compared with operators who had performed >20 pediatric liver biopsies during the study period (odds ratio 3.4 [1.3–9.1], P = 0.02). No association between the number of biopsies performed by the operator during the 2 years preceding the date of the biopsy and complications was found.

Conclusions: Major complications are infrequent after pediatric liver biopsies and no relation between operator experience and major complications was found. We found a significant, but minor, effect of operator procedure frequency on the rate of minor bleeding incidents after ultrasound-guided pediatric liver biopsies.

*Department of Pediatric Research, Women and Children's Division

Department of Radiology, Rikshospitalet, Oslo University Hospital

Department of Paediatric Medicine, Women and Children's Division, Oslo University Hospital, Oslo, Norway.

Address correspondence and reprint requests to Runar Almaas, MD, PhD, Department of Pediatric Research, Oslo University Hospital, Pb 4950 Nydalen, 0424 Oslo, Norway (e-mail:

Received 6 April, 2013

Accepted 17 June, 2013

This study was supported by the Eckbo Foundation and by the Grimsgaard Foundation.

The authors report no conflicts of interest.

© 2013 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,