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Percutaneous Liver Biopsy: Pathologic Diagnosis and Complications in Children

Short, Scott S.*; Papillon, Stephanie*; Hunter, Catherine J.*; Stanley, Philip; Kerkar, Nanda; Wang, Larry§; Azen, Colleen||; Wang, Kasper*

Journal of Pediatric Gastroenterology and Nutrition: November 2013 - Volume 57 - Issue 5 - p 644–648
doi: 10.1097/MPG.0b013e3182a0e0d8
Original Articles: Hepatology and Nutrition

Objective: The aim of this study was to determine patient factors that predict diagnostic failure or increased risk of bleeding complications following percutaneous liver biopsy in children.

Methods: A retrospective review of all children undergoing percutaneous liver biopsy at a single institution between July 2008 and July 2011 was performed. Demographics, comorbid conditions, preprocedural diagnoses/indications, procedural details, laboratory data, pathologic diagnosis, and complications were recorded. Continuous data were analyzed by Wilcoxon test and categorical data by Fisher exact test to determine statistical significance.

Results: Two hundred thirteen children (104 girls) with a median age of 7 years (range 1 week–22 years) underwent 328 percutaneous liver biopsies. Nine (4.2%) experienced a decrease in hemoglobin >2 g/dL, 7 required transfusion (3.3%), and 1 patient died (0.5%). Younger age (1.8 vs 84 months, P = 0.05) and lower preprocedural hematocrit (29.3 vs 34.3, P = 0.05) predicted bleeding complications, whereas the number of biopsies, comorbid conditions, and coagulopathy did not. Sixty-three (19.2%) biopsies were insufficient for definitive histologic evaluation on initial biopsy in 57 patients. Twenty-one of 57 patients (37%) underwent repeat percutaneous biopsy and 3 of 57 (8%) underwent surgical biopsy. Biopsy provided definitive diagnosis in 86% of cases when repeat biopsy was performed. Shorter specimen length (1.4 vs 1.7 cm, P < 0.01) and biopsies performed for unexplained elevation of liver function tests (34.9% vs 16.7%, P < 0.01) were predictive of nondiagnosis.

Conclusions: Percutaneous liver biopsy is safe with a low rate of bleeding-related complications. Ensuring adequate sample length and careful patient selection may further increase the diagnostic yield.

*Department of Surgery

Department of Radiology

Department of Gastroenterology

§Department of Pathology, Children's Hospital Los Angeles

||Southern California Clinical and Translational Science Institute, University of Southern California and Children's Hospital Los Angeles, Los Angeles, CA.

Address correspondence and reprint requests to Kasper Wang, MD, Children's Hospital Los Angeles. 4650 Sunset Blvd, Mailstop 100, Los Angeles, CA 90027 (e-mail:

Received 19 April, 2013

Accepted 12 June, 2013

This article was presented in part at the meeting of the Southern California chapter of the American College of Surgeons in Santa Barbara, January 19, 2013.

This publication was supported by NIH/NCRR SC-CTSI grant no. UL1 RR031986. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The authors report no conflicts of interest.

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