Complications of percutaneous liver biopsy with Klatskin needles: a 36‐year single‐centre experience
Summary Background Liver biopsy is the gold standard in evaluating liver diseases but is susceptible to complications. Safety data on aspiration needle biopsies remain limited. Aim To evaluate the safety of percutaneous liver biopsy performed with Klatskin needle. Methods Clinical and biochemical da...
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| Veröffentlicht in: | Alimentary pharmacology & therapeutics 2017-03, Vol.45 (5), p.744-753 |
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| creator | Takyar, V. Etzion, O. Heller, T. Kleiner, D. E. Rotman, Y. Ghany, M. G. Fryzek, N. Williams, V. H. Rivera, E. Auh, S. Liang, T. J. Hoofnagle, J. H. Koh, C. |
| description | Summary
Background
Liver biopsy is the gold standard in evaluating liver diseases but is susceptible to complications. Safety data on aspiration needle biopsies remain limited.
Aim
To evaluate the safety of percutaneous liver biopsy performed with Klatskin needle.
Methods
Clinical and biochemical data were retrospectively retrieved from sequential subjects who underwent liver biopsy with Klatskin needle from 1978 to 2015. Subjects with complications underwent thorough chart reviews for hospital course.
Results
Of 3357 biopsies performed, complications occurred in 135 (4%) biopsies with 33 (1%) resulting in major complications. Severe pain occurred in 78 (2.3%) subjects and bleeding occurred in 21 (0.6%) subjects. Biliary injury occurred in 8 (0.2%) biopsies. Three subjects died as a result of massive intraperitoneal bleeding. Compared to viral hepatitis, biopsies performed with certain diagnosis had significantly higher odds of major complications: NRH (OR: 17), DILI (OR: 20), GVHD (OR: 32) and HCC (OR: 34). Subjects with major complications had higher pre‐biopsy median AP (153 vs. 78 U/L, P < 0.001), ALT (105 vs. 64 U/L, P < 0.05), AST (62 vs. 47 U/L, P < 0.02), along with marginally lower total bilirubin (1.0 vs. 0.7 mg/dL, P < 0.01) and albumin (3.7 vs. 4.0 g/dL, P < 0.001). By multivariate backward logistic regression, platelets ≤100 K/μL and aPTT >35 were independent risk factors of post‐biopsy bleeding.
Conclusion
Klatskin needle liver biopsies are safe with rare procedural morbidity. Our data suggests certain acutely ill subjects and those with systemic illnesses may be at higher risk of major complications. Clinicians should weigh the risks and benefits of liver biopsy in these patients with other alternative approaches.
Linked ContentThis article is linked to Takyar and Koh, and Ayubi et al papers. To view these articles visit https://doi.org/10.1111/apt.14170 and https://doi.org/10.1111/apt.14131. |
| doi_str_mv | 10.1111/apt.13939 |
| format | Article |
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Background
Liver biopsy is the gold standard in evaluating liver diseases but is susceptible to complications. Safety data on aspiration needle biopsies remain limited.
Aim
To evaluate the safety of percutaneous liver biopsy performed with Klatskin needle.
Methods
Clinical and biochemical data were retrospectively retrieved from sequential subjects who underwent liver biopsy with Klatskin needle from 1978 to 2015. Subjects with complications underwent thorough chart reviews for hospital course.
Results
Of 3357 biopsies performed, complications occurred in 135 (4%) biopsies with 33 (1%) resulting in major complications. Severe pain occurred in 78 (2.3%) subjects and bleeding occurred in 21 (0.6%) subjects. Biliary injury occurred in 8 (0.2%) biopsies. Three subjects died as a result of massive intraperitoneal bleeding. Compared to viral hepatitis, biopsies performed with certain diagnosis had significantly higher odds of major complications: NRH (OR: 17), DILI (OR: 20), GVHD (OR: 32) and HCC (OR: 34). Subjects with major complications had higher pre‐biopsy median AP (153 vs. 78 U/L, P < 0.001), ALT (105 vs. 64 U/L, P < 0.05), AST (62 vs. 47 U/L, P < 0.02), along with marginally lower total bilirubin (1.0 vs. 0.7 mg/dL, P < 0.01) and albumin (3.7 vs. 4.0 g/dL, P < 0.001). By multivariate backward logistic regression, platelets ≤100 K/μL and aPTT >35 were independent risk factors of post‐biopsy bleeding.
Conclusion
Klatskin needle liver biopsies are safe with rare procedural morbidity. Our data suggests certain acutely ill subjects and those with systemic illnesses may be at higher risk of major complications. Clinicians should weigh the risks and benefits of liver biopsy in these patients with other alternative approaches.
Linked ContentThis article is linked to Takyar and Koh, and Ayubi et al papers. To view these articles visit https://doi.org/10.1111/apt.14170 and https://doi.org/10.1111/apt.14131.</description><identifier>ISSN: 0269-2813</identifier><identifier>EISSN: 1365-2036</identifier><identifier>DOI: 10.1111/apt.13939</identifier><identifier>PMID: 28074540</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Adolescent ; Adult ; Aged ; Albumin ; Bilirubin ; Biopsy ; Biopsy, Needle - adverse effects ; Bleeding ; Complications ; Female ; Graft-versus-host reaction ; Hemorrhage - etiology ; Hepatitis ; Humans ; Liver ; Liver diseases ; Liver Diseases - diagnosis ; Logistic Models ; Male ; Middle Aged ; Morbidity ; Needles ; Pain ; Pain - etiology ; Platelets ; Retrospective Studies ; Risk Factors ; Young Adult</subject><ispartof>Alimentary pharmacology & therapeutics, 2017-03, Vol.45 (5), p.744-753</ispartof><rights>Published 2017. This article is a U.S. Government work and is in the public domain in the USA.</rights><rights>Copyright © 2017 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4439-a78548ac6265685ed6af807118ac56b48d31838b471f97ee4db22f86f1113d383</citedby><cites>FETCH-LOGICAL-c4439-a78548ac6265685ed6af807118ac56b48d31838b471f97ee4db22f86f1113d383</cites><orcidid>0000-0002-2895-3095</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fapt.13939$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fapt.13939$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28074540$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Takyar, V.</creatorcontrib><creatorcontrib>Etzion, O.</creatorcontrib><creatorcontrib>Heller, T.</creatorcontrib><creatorcontrib>Kleiner, D. E.</creatorcontrib><creatorcontrib>Rotman, Y.</creatorcontrib><creatorcontrib>Ghany, M. G.</creatorcontrib><creatorcontrib>Fryzek, N.</creatorcontrib><creatorcontrib>Williams, V. H.</creatorcontrib><creatorcontrib>Rivera, E.</creatorcontrib><creatorcontrib>Auh, S.</creatorcontrib><creatorcontrib>Liang, T. J.</creatorcontrib><creatorcontrib>Hoofnagle, J. H.</creatorcontrib><creatorcontrib>Koh, C.</creatorcontrib><title>Complications of percutaneous liver biopsy with Klatskin needles: a 36‐year single‐centre experience</title><title>Alimentary pharmacology & therapeutics</title><addtitle>Aliment Pharmacol Ther</addtitle><description>Summary
Background
Liver biopsy is the gold standard in evaluating liver diseases but is susceptible to complications. Safety data on aspiration needle biopsies remain limited.
Aim
To evaluate the safety of percutaneous liver biopsy performed with Klatskin needle.
Methods
Clinical and biochemical data were retrospectively retrieved from sequential subjects who underwent liver biopsy with Klatskin needle from 1978 to 2015. Subjects with complications underwent thorough chart reviews for hospital course.
Results
Of 3357 biopsies performed, complications occurred in 135 (4%) biopsies with 33 (1%) resulting in major complications. Severe pain occurred in 78 (2.3%) subjects and bleeding occurred in 21 (0.6%) subjects. Biliary injury occurred in 8 (0.2%) biopsies. Three subjects died as a result of massive intraperitoneal bleeding. Compared to viral hepatitis, biopsies performed with certain diagnosis had significantly higher odds of major complications: NRH (OR: 17), DILI (OR: 20), GVHD (OR: 32) and HCC (OR: 34). Subjects with major complications had higher pre‐biopsy median AP (153 vs. 78 U/L, P < 0.001), ALT (105 vs. 64 U/L, P < 0.05), AST (62 vs. 47 U/L, P < 0.02), along with marginally lower total bilirubin (1.0 vs. 0.7 mg/dL, P < 0.01) and albumin (3.7 vs. 4.0 g/dL, P < 0.001). By multivariate backward logistic regression, platelets ≤100 K/μL and aPTT >35 were independent risk factors of post‐biopsy bleeding.
Conclusion
Klatskin needle liver biopsies are safe with rare procedural morbidity. Our data suggests certain acutely ill subjects and those with systemic illnesses may be at higher risk of major complications. Clinicians should weigh the risks and benefits of liver biopsy in these patients with other alternative approaches.
Linked ContentThis article is linked to Takyar and Koh, and Ayubi et al papers. To view these articles visit https://doi.org/10.1111/apt.14170 and https://doi.org/10.1111/apt.14131.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Albumin</subject><subject>Bilirubin</subject><subject>Biopsy</subject><subject>Biopsy, Needle - adverse effects</subject><subject>Bleeding</subject><subject>Complications</subject><subject>Female</subject><subject>Graft-versus-host reaction</subject><subject>Hemorrhage - etiology</subject><subject>Hepatitis</subject><subject>Humans</subject><subject>Liver</subject><subject>Liver diseases</subject><subject>Liver Diseases - diagnosis</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Needles</subject><subject>Pain</subject><subject>Pain - etiology</subject><subject>Platelets</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Young Adult</subject><issn>0269-2813</issn><issn>1365-2036</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kctu1DAYRi0EosPAghdAltjAIq3vcVhUqkbcRCVYlLXlJH86Lh472EnL7HgEnpEnwW1KBUh4Y9k-Ov7sD6GnlBzSMo7sOB1S3vDmHlpRrmTFCFf30Yow1VRMU36AHuV8QQhRNWEP0QHTpBZSkBXabuJu9K6zk4sh4zjgEVI3TzZAnDP27hISbl0c8x5fuWmLP3g75S8u4ADQe8ivsMVc_fz-Yw824ezCuYey6iBMCTB8KzoHoYPH6MFgfYYnt_MafX7z-mzzrjr9-Pb95uS06oTgTWVrLYW2nWJKKi2hV3YoYSkte1K1Qvecaq5bUdOhqQFE3zI2aDWUf-A913yNjhfvOLc76G9yWG_G5HY27U20zvx9EtzWnMdLI1lDGGmK4MWtIMWvM-TJ7FzuwPvlSwzVsq5lSXF91_N_0Is4p1CeZ2jDmBCClFRr9HKhuhRzTjDchaHEXPdnSn_mpr_CPvsz_R35u7ACHC3AlfOw_7_JnHw6W5S_AIrYp3E</recordid><startdate>201703</startdate><enddate>201703</enddate><creator>Takyar, V.</creator><creator>Etzion, O.</creator><creator>Heller, T.</creator><creator>Kleiner, D. E.</creator><creator>Rotman, Y.</creator><creator>Ghany, M. G.</creator><creator>Fryzek, N.</creator><creator>Williams, V. H.</creator><creator>Rivera, E.</creator><creator>Auh, S.</creator><creator>Liang, T. J.</creator><creator>Hoofnagle, J. H.</creator><creator>Koh, C.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>M7N</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-2895-3095</orcidid></search><sort><creationdate>201703</creationdate><title>Complications of percutaneous liver biopsy with Klatskin needles: a 36‐year single‐centre experience</title><author>Takyar, V. ; Etzion, O. ; Heller, T. ; Kleiner, D. E. ; Rotman, Y. ; Ghany, M. G. ; Fryzek, N. ; Williams, V. H. ; Rivera, E. ; Auh, S. ; Liang, T. J. ; Hoofnagle, J. H. ; Koh, C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4439-a78548ac6265685ed6af807118ac56b48d31838b471f97ee4db22f86f1113d383</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Albumin</topic><topic>Bilirubin</topic><topic>Biopsy</topic><topic>Biopsy, Needle - adverse effects</topic><topic>Bleeding</topic><topic>Complications</topic><topic>Female</topic><topic>Graft-versus-host reaction</topic><topic>Hemorrhage - etiology</topic><topic>Hepatitis</topic><topic>Humans</topic><topic>Liver</topic><topic>Liver diseases</topic><topic>Liver Diseases - diagnosis</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Needles</topic><topic>Pain</topic><topic>Pain - etiology</topic><topic>Platelets</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Takyar, V.</creatorcontrib><creatorcontrib>Etzion, O.</creatorcontrib><creatorcontrib>Heller, T.</creatorcontrib><creatorcontrib>Kleiner, D. E.</creatorcontrib><creatorcontrib>Rotman, Y.</creatorcontrib><creatorcontrib>Ghany, M. G.</creatorcontrib><creatorcontrib>Fryzek, N.</creatorcontrib><creatorcontrib>Williams, V. H.</creatorcontrib><creatorcontrib>Rivera, E.</creatorcontrib><creatorcontrib>Auh, S.</creatorcontrib><creatorcontrib>Liang, T. J.</creatorcontrib><creatorcontrib>Hoofnagle, J. H.</creatorcontrib><creatorcontrib>Koh, C.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Alimentary pharmacology & therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Takyar, V.</au><au>Etzion, O.</au><au>Heller, T.</au><au>Kleiner, D. E.</au><au>Rotman, Y.</au><au>Ghany, M. G.</au><au>Fryzek, N.</au><au>Williams, V. H.</au><au>Rivera, E.</au><au>Auh, S.</au><au>Liang, T. J.</au><au>Hoofnagle, J. H.</au><au>Koh, C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Complications of percutaneous liver biopsy with Klatskin needles: a 36‐year single‐centre experience</atitle><jtitle>Alimentary pharmacology & therapeutics</jtitle><addtitle>Aliment Pharmacol Ther</addtitle><date>2017-03</date><risdate>2017</risdate><volume>45</volume><issue>5</issue><spage>744</spage><epage>753</epage><pages>744-753</pages><issn>0269-2813</issn><eissn>1365-2036</eissn><abstract>Summary
Background
Liver biopsy is the gold standard in evaluating liver diseases but is susceptible to complications. Safety data on aspiration needle biopsies remain limited.
Aim
To evaluate the safety of percutaneous liver biopsy performed with Klatskin needle.
Methods
Clinical and biochemical data were retrospectively retrieved from sequential subjects who underwent liver biopsy with Klatskin needle from 1978 to 2015. Subjects with complications underwent thorough chart reviews for hospital course.
Results
Of 3357 biopsies performed, complications occurred in 135 (4%) biopsies with 33 (1%) resulting in major complications. Severe pain occurred in 78 (2.3%) subjects and bleeding occurred in 21 (0.6%) subjects. Biliary injury occurred in 8 (0.2%) biopsies. Three subjects died as a result of massive intraperitoneal bleeding. Compared to viral hepatitis, biopsies performed with certain diagnosis had significantly higher odds of major complications: NRH (OR: 17), DILI (OR: 20), GVHD (OR: 32) and HCC (OR: 34). Subjects with major complications had higher pre‐biopsy median AP (153 vs. 78 U/L, P < 0.001), ALT (105 vs. 64 U/L, P < 0.05), AST (62 vs. 47 U/L, P < 0.02), along with marginally lower total bilirubin (1.0 vs. 0.7 mg/dL, P < 0.01) and albumin (3.7 vs. 4.0 g/dL, P < 0.001). By multivariate backward logistic regression, platelets ≤100 K/μL and aPTT >35 were independent risk factors of post‐biopsy bleeding.
Conclusion
Klatskin needle liver biopsies are safe with rare procedural morbidity. Our data suggests certain acutely ill subjects and those with systemic illnesses may be at higher risk of major complications. Clinicians should weigh the risks and benefits of liver biopsy in these patients with other alternative approaches.
Linked ContentThis article is linked to Takyar and Koh, and Ayubi et al papers. To view these articles visit https://doi.org/10.1111/apt.14170 and https://doi.org/10.1111/apt.14131.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28074540</pmid><doi>10.1111/apt.13939</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-2895-3095</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Wiley Free Content; MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Adolescent Adult Aged Albumin Bilirubin Biopsy Biopsy, Needle - adverse effects Bleeding Complications Female Graft-versus-host reaction Hemorrhage - etiology Hepatitis Humans Liver Liver diseases Liver Diseases - diagnosis Logistic Models Male Middle Aged Morbidity Needles Pain Pain - etiology Platelets Retrospective Studies Risk Factors Young Adult |
| title | Complications of percutaneous liver biopsy with Klatskin needles: a 36‐year single‐centre experience |
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