Güven KAHRİMAN, Nevzat ÖZCAN, Halil DÖNMEZ, Ertuğrul MAVİLİ, Kemal DENİZ

Transjugular liver biopsy: Results of 97 patients

Amaç: Perkütan biyopsinin kontrendike olduğu hastalarda transjuguler karaciğer biyopsisinin etkinliğini değerlendirmektir. Hastalar ve Yöntem: Haziran 2005-Nisan 2010 tarihleri arasında transjuguler biyopsi yapılan 97 hasta çalışmaya dahil edildi. Bütün biyopsiler 18 gauge Quick-Core biyopsi seti ile internal juguler venden girilerek sağ hepatik ven yoluyla yapıldı. Klinik endikasyon, histopatolojik tanı ve komplikasyonlar kaydedildi. Bulgular: Teknik başarı 93 hastada (%95,8) sağlandı. İki Hastada hepatik venler kateterize ve opasifiye edilemedi. İki hastada ise hepatik ven kateterize ve opasifiye edilmesine rağmen, inferior vena kava ile hepatik ven arasındaki akut açılanma nedeni ile biyopsi iğnesi karaciğere ilerletilemedi. Her hastadan en az iki örnek alındı. Histopatolojik tanıların çoğu sirozdu. Bir hastada giriş yerinde cilt altı hematom gelişti. Sonuç: Perkütan biyopsinin kontrendike olduğu durumlarda transjuguler karaciğer biyopsisi etkili ve uygulanabilir alternatif yöntemdir.

Transjuguler karaciğer biyopsisi, karaciğer biyopsisi, karaciğer sirozu

Objective: To evaluate the feasibility and efficacy of transjugular liver biopsy in patients with contraindicated percutaneous biopsy. Materials and Methods: Between June 2005 and April 2010, 97 patients who were admitted for transjugular liver biopsy were enrolled in this retrospective study. All liver biopsies were obtained using an 18 gauge Quick-Core liver biopsy set through the right hepatic vein via the internal jugular vein. Clinical indication, histopathological diagnosis, and complications were noted. Results: Primary technical success was achieved in 93 (95.8%) patients. Hepatic veins could not be catheterized and opacified in two patients and in the remaining two patients the veins could be opacified and catheterized but we were not able to pass the biopsy needle into the hepatic vein because of the acute angle between the inferior vena cava and hepatic veins. At least two specimens were obtained from each patient. The most frequent histopathological diagnosis was cirrhosis. A subcutaneous hematoma around the puncture side was encountered in one patient. Conclusion: Transjugular liver biopsy is a feasible and effective alternative in patients with contraindication for percutaneous biopsy.

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1. Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med 2001;344:495-500. [CrossRef]
2. Dotter CT. Catheter biopsy. Experimental technique for transvenous liver biopsy. Radiology 1964;82:312-4.
3. Guido M, Rugge M. Liver biopsy sampling in chronic viral hepatitis. Semin Liver Dis 2004;24:89-97. [CrossRef]
4. Sheela H, Seela S, Caldwell C, Boyer JL, Jain D. Liver biopsy: evolving role in the new millenium. J Clin Gastroenterol 2005;39:603-10. [CrossRef]
5. Lebrec D. Various approaches to obtaining liver tissue-choosing the biopsy technique. J Hepatol 1996;25:20-4.
6. Zamcheck N, Klausenstock O. Medical progress: liver biopsy-the risk of needle biopsy. N Engl J Med 1953;249:1062-9. [CrossRef]
7. Velt PM, Choy OG, Shimkin PM, Link RJ. Transjugular liver biopsy in high-risk patients with hepatic disease. Radiology. 1984;153:91-3.
8. Piccinino F, Sagnelli E, Pasquale G, Giusti G. Complications following percutaneous liver biopsy: a multicentre retrospective study on 68, 276 biopsies. J Hepatol 1986;2:165-73. [CrossRef]
9. Mammen T, Keshava SN, Eapen CE, Raghuram L, Moses V, Gopi K, et al. Transjugular liver biopsy: a retrospective analysis of 601 cases. J Vasc Interv Radiol 2008;19:351-8. [CrossRef]
10. Shulman HM, Gooley T, Dudley MD, Kofler T, Feldman R, Dwyer D, et al. Utility of transvenous liver biopsies and wedged hepatic venous pressure measurements in sixty marrow transplant recipients. Transplantation 1995;59:1015-22. [CrossRef]
11. Lebrec D, Goldfarb G, Degott C, Rueff B, Benhamou JP. Transvenous liver biopsy: an experience based on 1000 hepatic tissue samplings with this procedure. Gastroenterology 1982;83:338-40.
12. Kardache M, Soyer P, Boudiaf M, Cochand-Priollet B, Pelage JP, Rymer R. Transjugular liver biopsy with an automated device. Radiology 1997;204:369-72.
13. Bruzzi JF, O’Connell MJ, Thakore H, O’Keane C, Crowe J, Murray JG. Transjugular liver biopsy: assessment of safety and efficacy of the Quick-Core biopsy needle. Abdom Imaging 2002;27:711-5. [CrossRef]
14. Little AF, Zajko AB, Orons PD. Transjugular liver biopsy: prospective study in 43 patients with the Quick-Core biopsy needle. J Vasc Interv Radiol 1996;7:127-31. [CrossRef]
15. Duncan IC, Fourie PA. Percutaneous management of concomitant post-traumatic high vertebrovertebral and caroticojugular fistulas using balloons, coils, and a covered stent. J Endovasc Ther 2003;10:882-6. [CrossRef]
16. Ramsay DW, McAuliffe W. Traumatic pseudoaneurysm and high flow arteriovenous fistula involving internal jugular vein and common carotid artery. Treatment with covered stent and embolization. Australas Radiol 2003;47:177-80. [CrossRef]
17. De Hoyos A, Loredo ML, Martínez-Ríos MA, Gil MR, Kuri J, Cárdenas M. Transjugular liver biopsy in 52 patients with an automated Trucut-type needle. Dig Dis Sci 1999;44:177-80. [CrossRef]
18. Khosa F, McNulty JG, Hickey N, O’Brien P, Tobin A, Noonan N, et al. Transvenous liver biopsy via the femoral vein. Clin Radiol 2003;58:487-91. [CrossRef]
19. Kalambokis G, Manousou P, Vibhakorn S, Marelli L, Cholongitas E, Senzolo M, et al. Transjugular liver biopsy-indications, adequacy, quality of specimens, and complications. J Hepatol 2007;47:284-94. [CrossRef]
20. Soyer P, Fargeaudou Y, Boudiaf M, Rymer R. Transjugular liver biopsy using ultrasonographic guidance for jugular vein puncture and an automated device for hepatic tissue sampling: a retrospective analysis of 200 consecutive cases. Abdom Imaging 2008;33:627-32. [CrossRef]
21. Chevallier P, Dausse F, Berthier F, Saint-Paul MC, Denys A, Schnyder P, et al. Transjugular liver biopsy: prospective evaluation of the angle formed between the hepatic veins and the vena cava main axis and modification of a semi-automated biopsy device in cases of an unfavorable angle. Eur Radiol 2007;17:169-73. [CrossRef]
22. Soyer P, Lacheheb D, Levesque M. High-resolution sonographic guidance for transjugular liver biopsy. Abdom Imaging 1993;18:360-2. [CrossRef]
23. Sporea I, Sirli R, Popescu A, Cornianu M, Manciu C, Focsa M. The quality of the fragment obtained by liver biopsy for staging chronic hepatitis. J Gastrointestin Liver Dis 2007;16:263-6.
24. Bedossa P, Dargère D, Paradis V. Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology 2003;38:1449-57. [CrossRef]