Abstract
Background
Percutaneous liver biopsy (PLB) is considered the gold standard method for the diagnosis of liver diseases. The most feared complication is major bleeding, reported in about 1% of the biopsies performed in adults, believed to occur more frequently in children.
Aims
To compare the effectiveness and safety of PLB in children according to training level (trainees vs. staff).
Methods
Retrospective single center study. Biopsies over a period of 8 years were reviewed (February 2010 - April 2018). The procedure was performed under sedation with Midazolam and Dextroketamine after the puncture site was demarcated with ultrasonography. Biopsies were performed either by first year pediatric gastroenterology fellows or by experienced staff, using Menghini technique. Complications and number of attempts/ punctures were analyzed according to the level of training of the physician performing the biopsy.
Results
A total of 212 PLB were performed. 54.6% of patients were females, with a median age of 3.3 years. The main indication for the biopsy was neonatal cholestasis, in 27.9%. The biopsy was performed by trainees in 81.5% (167) of cases. The number of punctures to obtain a satisfactory sample ranged from 1 to 5, with decreasing frequencies of 52.5%, 32.9%, 20.6%, 2.7%, and 1.1% respectively. Fragments were considered appropriate for histological diagnosis in 95.6% of the biopsies performed. Drop in hemoglobin greater than 15 and 20 g/L were registered in 14.1% and 6.3% of patients, respectively, while bleeding with clinical repercussion occurred in 0.9% - 2 out of the 205 patients (one of these needed a surgical intervention). No differences were observed between the groups (fellows vs. staff physicians) regarding the number of punctures to obtain a satisfactory sample (median of 1.7 in both groups), drop in hemoglobin (median of 0.7 vs. 0.5 g/L), the occurrence of bleeding with clinical repercussion (both events in the trainee group) or sampling of non-representative biopsies (4.2 vs. 2.6%).
Conclusions
Percutaneous liver biopsy is a safe procedure in children. The incidence of major bleeding in this population is similar to that reported in adults. Complications of the procedure did not differ on biopsies performed by first year gastroenterology fellows and staff physicians.
Funding Agencies
None