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Letters to the Editor

Comparison of Transjugular Liver Biopsy and Percutaneous Liver Biopsy With Tract Embolization in Pediatric Patients

Tulin-Silver, Sheryl; Lungren, Matthew P.

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Journal of Pediatric Gastroenterology and Nutrition: April 2019 - Volume 68 - Issue 4 - p e71
doi: 10.1097/MPG.0000000000002290
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To the Editor: As Khemka et al highlight, the transjugular liver biopsy (TJLB) and percutaneous liver biopsy (PLB) groups in our study were not ideally matched with respect to laboratory values or demographics. This flaw is common to retrospective analyses. Given lack of similar data, our study offers important if not compelling experiential data from an advanced practice. There remain clinical scenarios in which TJLB may not be possible; examples include fulminant hepatic failure in small infants or urgent biopsy in intensive care unit patients who cannot be transported to the fluoroscopy suite. It will come as no surprise to experienced interventional radiologists that the standard TJLB device is oversized in small pediatric patients, leading to improvisation with alternative equipment to perform a biopsy endovascularly if only to avoid PLB; the risks of thrombus, arrhythmia, and damaging the IVC during TJLB, or of not performing the biopsy at all, are of concern. Guidelines, informed by scarce available evidence, are of limited use directing care in these scenarios. Our series, the largest in the pediatric literature, may offer another option for patients with laboratory values outside society guidelines and suggests PLB with gelatin sponge pledget tract embolization can be used safely in high-risk children particularly if TJLB is not feasible. No bleeding complications following PLB with tract embolization in patients with coagulopathy (INR >1.7) or significant ascites underlies this conclusion. Like the authors of the letter, we too look forward to future efforts prospectively comparing techniques, but in the meantime, we sincerely hope other practices will benefit from our practice-based evidence.

Copyright © 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition