1
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Kim J, Kamiyama N, Tanigawa S, Yoon H, Lim HJ, Lee MJ. Application of a quality threshold to improve liver shear wave elastography measurements in free-breathing pediatric patients. Ultrasonography 2024; 43:354-363. [PMID: 39112092 PMCID: PMC11374582 DOI: 10.14366/usg.24054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/07/2024] [Indexed: 09/04/2024] Open
Abstract
PURPOSE This study assessed the benefits of quality threshold (QT) implementation for liver shear wave elastography (SWE) in children during free breathing. METHODS The QT, which adjusts the SWE map display based on shear wave quality, was set at 55%. Phantom measurements (PMs) were taken with a fixed probe using QT (termed PM-1); a moving probe without QT (PM-2); and a moving probe with QT (PM-3). Each measurement was subjected to random samplings of various sizes. Clinical measurements (CMs) were obtained from children with biliary atresia using following protocols: CM-1, manually defined regions of interest (ROIs); CM-2, default ROIs without QT; and CM-3, default ROIs with QT. Elasticity measurements were compared across fibrosis grades, and color patterns on the SWE maps were analyzed. RESULTS In the phantom experiments, the moving probe produced lower elasticity measurements; this difference decreased upon QT application. With the moving probe, random sampling indicated fewer interquartile range-to-median ratios exceeding 30% upon QT application (4% vs. 14% when five values were sampled, P=0.004). In clinical experiments, QT improved the differentiation of fibrosis grade in patients over 5 years old, with a significant difference between moderate and severe fibrosis (P=0.004). Elasticity variability was positively correlated with fibrosis grade (τ=0.376, P<0.001). Certain apparent errors, termed artificial stripe patterns, were not eliminated by QT. CONCLUSION Applying QT to exclude low-quality pixels can minimize measurement error and improve differentiation of liver fibrosis grades. The presence of an artificial stripe pattern on the SWE map may indicate images requiring exclusion.
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Affiliation(s)
- Jisoo Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | | | - Haesung Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Ji Lim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mi-Jung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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2
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Jing H, Xu R, Qian L, Yi Z, Shi X, Li L, Sun L, Liu Y, He E. Prospective comparison of an 18-gauge versus 16-gauge needle for percutaneous liver core-needle biopsy in children. Abdom Radiol (NY) 2024; 49:604-610. [PMID: 37930448 DOI: 10.1007/s00261-023-04082-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 11/07/2023]
Abstract
PURPOSE The objective of this study was to analyzed the impact of needle gauge (G) on the adequacy of specimens and hemorrhagic complications in pediatric patients undergoing ultrasound (US)-guided transplanted liver biopsies. METHODS The study included 300 consecutive biopsies performed in 282 pediatric patients (mean age 6.75 ± 3.82 years, range 0.84-17.90) between December 2020 and April 2022. All pediatric patients that referred to our institution for US-guided core-needle liver biopsy (CNLB) were randomized to undergo 16-G or 18-G CNLB. Hemorrhagic complications were qualitatively evaluated. The number of complete portal tracts (CPTs) per specimen was counted and specimen adequacy was assessed based on the American Association for the Study of Liver Diseases guidelines. RESULTS The incidence of bleeding was 7.00% (n = 21) and adequate specimens for accurate pathological diagnosis were obtained from 98.33% (n = 295) of patients. There was no significant difference in the incidence or amount of bleeding between the 16-G and 18-G groups (11 vs 10, p = 0.821; 35.0 mL vs 31.3 mL, p = 0.705). Although biopsies obtained using a 16-G needle contained more complete portal tracts than those obtained using an 18-G needle (20.0 vs 18.0, p = 0.029), there was no significant difference in specimen inadequacy according to needle gauge (2 vs 3, p = 1.000). CONCLUSIONS Biopsy with a 16-G needle was associated with a greater number of CPTs but did not increase the adequate specimen rate. There was no significant difference in the complication rate between 16-G biopsy and 18-G biopsy.
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Affiliation(s)
- Haoyu Jing
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Ruifang Xu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Linxue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Zhanxiong Yi
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Xianquan Shi
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Li Li
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Liying Sun
- Department of Liver Transplantation Center, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Ying Liu
- Department of Liver Transplantation Center, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Enhui He
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China.
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3
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Kazci O, Kadirhan O, Uner C, Karavas E, Ucan B, Aydin S. Paediatric liver biopsies: A single-centre experience in Erzincan Binali Yıldırım University. ULTRASOUND (LEEDS, ENGLAND) 2024; 32:4-10. [PMID: 38314022 PMCID: PMC10836225 DOI: 10.1177/1742271x231157634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/31/2023] [Indexed: 12/14/2023]
Abstract
Introduction Liver biopsies are the main method in the diagnosis and treatment of paediatric liver pathologies. Major complication rates of paediatric liver biopsies range from 0% to 6.6% in the literature and minor complication rates range from 0% to 25%. In this study, we aimed to review the complications, indications and results of percutaneous core liver biopsies with paediatric sonography in a tertiary care centre by an interventional radiologist. Methods We retrospectively evaluated the results, indications and complications of paediatric liver biopsies performed in our tertiary health centre between January 2017 and December 2020. Biopsies were performed with a 16G semi-automatic needle in 17 patients (29.8%) and with an 18G semi-automatic needle in 40 patients (70.2%). Biopsies were performed only with local anaesthesia in patients older than 12 years; in younger patients, it was performed under general anaesthesia. Results Fifty-eight liver biopsies were obtained from 57 children (34 males, 23 females). The most common indications were elevated liver enzymes (33 patients), cholestasis (14 patients), and adiposity and metabolic problems (6 patents). The most common pathological diagnoses were chronic hepatitis (33 patients) and steatosis (10 patients). Major complication in the form of symptomatic subcapsular haematoma developed after liver biopsy performed with 18G needle in only one patient (1.8%). Conclusions As previously stated in the literature, percutaneous biopsies performed by interventional radiologists in paediatric patients under the guidance of sonography can be used in diagnosis and treatment; the complication rate is low and it is a safe method.
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Affiliation(s)
- Omer Kazci
- Department of Radiology, Faculty of Medicine, University of Higher Specialization, Ankara, Turkey
| | - Ozlem Kadirhan
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Cigdem Uner
- Department of Radiology, Dr Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Erdal Karavas
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Berna Ucan
- Department of Radiology, Dr Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Sonay Aydin
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey
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4
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Natali GL, Cassanelli G, Paolantonio G, Parapatt GK, Gregori LM, Rollo M. Pediatric liver cirrhosis interventional procedures: from biopsy to transjugular intrahepatic portosystemic shunt. Pediatr Radiol 2023; 53:727-738. [PMID: 36121496 PMCID: PMC10027841 DOI: 10.1007/s00247-022-05492-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/15/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
Cirrhosis is a complex diffuse process whereby the architecture of the liver is replaced by abnormal nodules because of the presence of fibrosis. Several pediatric diseases such as extrahepatic portal vein obstruction, biliary atresia, alpha-1-antitrypsin deficit and autoimmune hepatitis can lead to cirrhosis and portal hypertension in children. In this article the authors describe interventional radiology procedures that can facilitate the diagnosis and treatment of diseases associated with liver cirrhosis and portal hypertension in the pediatric population. These procedures include image-guided liver biopsy, mesenteric-intrahepatic left portal vein shunts, balloon-occluded retrograde transvenous obliteration, transjugular intrahepatic portosystemic shunts and splenic embolization.
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Affiliation(s)
- Gian Luigi Natali
- Interventional Radiology Unit in Oncohematology, Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio, 4, 00165, Rome, Italy.
| | - Giulia Cassanelli
- Interventional Radiology Unit in Oncohematology, Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio, 4, 00165, Rome, Italy
| | | | | | | | - Massimo Rollo
- Interventional Radiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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5
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Ehsan NA, Elsabaawy MM, Sweed DM, Karman EA, Abdelsameea E, Mohamed AA. Role of liver biopsy in management of liver diseases without hepatic nodules following end of the interferon era: experience of a tertiary referral center. Clin Exp Med 2023; 23:97-105. [PMID: 35262836 PMCID: PMC9939494 DOI: 10.1007/s10238-022-00797-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/20/2022] [Indexed: 11/27/2022]
Abstract
Liver biopsy (LB) is the cornerstone in the management of patients with liver diseases. However, a lot of queries had emerged about its role following the end of the interferon era. The aim of this study was to re-evaluate the current role of LB in the diagnosis of liver diseases. All patients who had underwent LB at the Department of Hepatology, National Liver Institute, from January 2015 through December 2018 were recruited. Indications for LB, pathology reports and medical records of all cases were retrieved, reviewed and statistically analyzed. A total of 275 liver biopsies were collected, 191 males and 84 females with mean age 41.22 ± 13.36 years. Etiological diagnosis made by histopathological evaluation was 48 drug-induced liver injury (DILI), 42 nonalcoholic fatty liver disease (NAFLD), 34 chronic hepatitis B, or C with cholestasis, 29 autoimmune hepatitis, 34 primary sclerosing cholangitis, 13 primary biliary cholangitis, 7 autoimmune overlap syndrome, 13 active bilharziasis and 10 Wilson's disease. Minor number of cases was diagnosed by different other etiologies. Initial diagnosis was made by liver biopsy and confirmed by clinical response and laboratory findings. Liver biopsy is still considered as the gold standard diagnostic measure of different liver diseases representing an integral component of management decisions in hepatology.
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Affiliation(s)
- Nermine A Ehsan
- Department of Pathology, National Liver Institute, Menoufia University, Shebeen El-Koom, Egypt
| | - Maha M Elsabaawy
- Hepatology and Gasteroenterology, National Liver Institute, Menoufia University, Shebeen El-Koom, 32511, Egypt
| | - Dina M Sweed
- Department of Pathology, National Liver Institute, Menoufia University, Shebeen El-Koom, Egypt
| | - Esraa A Karman
- Department of Pathology, National Liver Institute, Menoufia University, Shebeen El-Koom, Egypt
| | - Eman Abdelsameea
- Hepatology and Gasteroenterology, National Liver Institute, Menoufia University, Shebeen El-Koom, 32511, Egypt.
| | - Anwar A Mohamed
- Hepatology and Gasteroenterology, National Liver Institute, Menoufia University, Shebeen El-Koom, 32511, Egypt
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6
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Quelhas P, Jacinto J, Cerski C, Oliveira R, Oliveira J, Carvalho E, dos Santos J. Protocols of Investigation of Neonatal Cholestasis-A Critical Appraisal. Healthcare (Basel) 2022; 10:2012. [PMID: 36292464 PMCID: PMC9602084 DOI: 10.3390/healthcare10102012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 11/04/2022] Open
Abstract
Neonatal cholestasis (NC) starts during the first three months of life and comprises extrahepatic and intrahepatic groups of diseases, some of which have high morbimortality rates if not timely identified and treated. Prolonged jaundice, clay-colored or acholic stools, and choluria in an infant indicate the urgent need to investigate the presence of NC, and thenceforth the differential diagnosis of extra- and intrahepatic causes of NC. The differential diagnosis of NC is a laborious process demanding the accurate exclusion of a wide range of diseases, through the skillful use and interpretation of several diagnostic tests. A wise integration of clinical-laboratory, histopathological, molecular, and genetic evaluations is imperative, employing extensive knowledge about each evaluated disease as well as the pitfalls of each diagnostic test. Here, we review the difficulties involved in correctly diagnosing the cause of cholestasis in an affected infant.
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Affiliation(s)
- Patricia Quelhas
- Faculty of Health Sciences, Health Science Investigation Center of University of Beira Interior (CICS-UBI), 6200-506 Covilha, Portugal
| | - Joana Jacinto
- Medicine Department, University of Beira Interior (UBI), Faculty of Health Sciences, 6201-001 Covilha, Portugal
| | - Carlos Cerski
- Pathology Department of Universidade Federal do Rio Grande do Sul (UFRGS), Pathology Service of Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, Brazil
| | - Rui Oliveira
- Centro de Diagnóstico Histopatológico (CEDAP), 3000-377 Coimbra, Portugal
| | - Jorge Oliveira
- Center for Predictive and Preventive Genetics (CGPP), IBMC, UnIGENe, i3S, University of Porto, 4200-135 Porto, Portugal
| | - Elisa Carvalho
- Department of Gastroenterology and Hepatology, Hospital de Base do Distrito Federal, Hospital da Criança de Brasília, Brasília 70330-150, Brazil
| | - Jorge dos Santos
- Faculty of Health Sciences, Health Science Investigation Center of University of Beira Interior (CICS-UBI), 6200-506 Covilha, Portugal
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7
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Kurakawa KI, Okada A, Bessho K, Jo T, Ono S, Michihata N, Kumazawa R, Matsui H, Fushimi K, Yamaguchi S, Yamauchi T, Nangaku M, Kadowaki T, Yasunaga H. Major complications after percutaneous biopsy of native or transplanted liver in pediatric patients: a nationwide inpatient database study in Japan. BMC Gastroenterol 2022; 22:395. [PMID: 36002811 PMCID: PMC9404589 DOI: 10.1186/s12876-022-02476-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/03/2022] [Indexed: 11/12/2022] Open
Abstract
Aim Although major complication rates following percutaneous liver biopsy (PLB) have been reported to be higher in children than in adults, scarce data are available regarding pediatric patients stratified by native and transplanted liver. We aimed to assess the factors associated with major complications after percutaneous biopsy of native or transplanted liver using a nationwide inpatient database.
Methods Using the Japanese Diagnosis Procedure Combination database, we retrospectively identified pediatric patients who underwent PLB between 2010 and 2018. We described major complication rates and analyzed factors associated with major complications following PLB, stratified by native and transplanted liver. Results We identified 3584 pediatric PLBs among 1732 patients from 239 hospitals throughout Japan during the study period, including 1310 in the native liver and 2274 in the transplanted liver. Major complications following PLB were observed in 0.5% (n = 18) of the total cases; PLB in the transplanted liver had major complications less frequently than those in the native liver (0.2% vs. 1.0%, p = 0.002). The occurrence of major complications was associated with younger age, liver cancers, unscheduled admission, anemia or coagulation disorders in cases with native liver, while it was associated with younger age alone in cases with transplanted liver. Conclusions The present study, using a nationwide database, found that major complications occurred more frequently in pediatric cases with native liver and identified several factors associated with its major complications.
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Affiliation(s)
- Kayo Ikeda Kurakawa
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Pediatrics, National Rehabilitation Center for Persons With Disabilities, Saitama, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Bessho
- Department of Pediatrics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sachiko Ono
- Department of Eat-Loss Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Satoko Yamaguchi
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolism, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaomi Nangaku
- Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Kadowaki
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. .,Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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8
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Dionysopoulos G, Kalopitas G, Vadarlis A, Bakaloudi DR, Gkiourtzis N, Karanika E, Tsekitsidi E, Chourdakis M. Can omega-3 fatty acids be beneficial in pediatric NAFLD? A systematic review and meta-analysis. Crit Rev Food Sci Nutr 2022; 63:8545-8553. [PMID: 35400251 DOI: 10.1080/10408398.2022.2062589] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease in children and no medications or supplements are currently recommended. The role of omega-3 (n-3) fatty acids has been investigated in clinical trials with promising results. The aim of this study is to provide a detailed summary of the evidence about the efficacy of n-3 in the treatment of pediatric NAFLD. A systematic literature search was performed through major electronic databases up to September 20, 2021 for randomized placebo-controlled trials, investigating the efficacy of n-3 fatty acids in children with NAFLD. The primary outcomes were changes in serum transaminases concentration, Body Mass Index (BMI) and improvement of ultrasonographic liver steatosis. The secondary outcomes were changes in the patients' serum lipid profile, γ-glutamyl transferase (GGT), fasting blood glucose (FBG), homeostatic model assessment of insulin resistance (ΗΟΜΑ-ΙR) and waist circumference (WC). Results were expressed as mean differences for continuous outcomes and odds ratios for dichotomous outcomes with 95% confidence intervals. Six RCTs (n = 378 patients) were included. Treatment with n-3, compared to placebo, resulted in a statistically significant reduction in transaminases concentration. In addition, a significant improvement in liver steatosis assessed by ultrasonography and a decrease in BMI were observed. N-3 fatty acids supplementation seems to be an effective alternative treatment in pediatric NAFLD by improving liver biochemistry, ultrasonographic steatosis and BMI. Further research is required concerning the effect of n-3 fatty acids in liver histology.
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Affiliation(s)
- Georgios Dionysopoulos
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Kalopitas
- Division of Gastroenterology and Hepatology, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Vadarlis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Gastroenterology and Hepatology, General Hospital of Thessaloniki "G. Papanikolaou,"Thessaloniki, Greece
| | - Dimitra Rafailia Bakaloudi
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Gkiourtzis
- 4th Department of Paediatrics, Papageorgiou University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia Karanika
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eirini Tsekitsidi
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michail Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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9
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Osawa I, Ide K, Sakamoto S, Uchida H, Fukuda A, Nishimura N, Haga C, Yoshioka T, Nosaka S, Nakagawa S, Kasahara M. Hematological and biochemical characteristics and diagnostic imaging results in acute T cell-mediated rejection after pediatric liver transplantation. Pediatr Transplant 2022; 26:e14161. [PMID: 34617637 DOI: 10.1111/petr.14161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/24/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Liver biopsy is the gold standard for diagnosing TCMR after LT. However, complications caused by liver biopsy may occur especially during the immediate post-transplantation period and other effective methods for predicting TCMR have not been established. Thus, we investigated whether hematological and biochemical characteristics and Doppler ultrasonography findings are associated with acute TCMR. METHODS A multiple logistic regression analysis was performed to identify the prognostic factors of acute TCMR, defined as a RAI ≥4. Then, a ROC curve analysis was conducted to evaluate for diagnostic performance. The relationship between prognostic factors and each histological category of RAI was investigated. RESULTS Eighty-nine liver biopsies were performed on 85 patients between January 2012 and December 2019. The RAI of 62 (69.7%) liver biopsies was ≥4. AEC (×104 /μl), direct bilirubin level (mg/dl), and MHVV (cm/s) were found to be associated with acute TCMR (OR: 4.96, 95% CI: 1.44-17.0, p = .011; OR: 1.41, 95% CI: 1.04-1.91, p = .025; OR: 1.05, 95% CI: 1.02-1.08, p < .001, respectively). The area under the ROC curves for predicting acute TCMR was 0.86 (95% CI: 0.78-0.94). There was a correlation between AEC, direct bilirubin level, and MHVV as well as the severity of RAI. CONCLUSIONS AEC, direct bilirubin level, and MHVV were the independent risk factors for acute TCMR. This study could provide information regarding the identification of patients requiring liver biopsy.
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Affiliation(s)
- Ichiro Osawa
- Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kentaro Ide
- Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Seisuke Sakamoto
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Hajime Uchida
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Akinari Fukuda
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Nao Nishimura
- Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Chizuko Haga
- Department of Pathology, National Center for Child Health and Development, Tokyo, Japan
| | - Takako Yoshioka
- Department of Pathology, National Center for Child Health and Development, Tokyo, Japan
| | - Shunsuke Nosaka
- Division of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Satoshi Nakagawa
- Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Mureo Kasahara
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
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10
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Hirvonen M, Sinikumpu JJ, Tervonen O, Sequeiros RB. Magnetic resonance imaging-guided biopsies in children. Acta Radiol Open 2021; 10:20584601211053846. [PMID: 34868661 PMCID: PMC8638078 DOI: 10.1177/20584601211053846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 09/28/2021] [Indexed: 12/13/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) is used far less as an imaging-guided method
for percutaneous biopsies than computed tomography (CT) and ultrasound (US),
despite its imaging benefits, particularly in children. Purpose To evaluate the feasibility, accuracy and safety of MRI-guided biopsies in
paediatric patient population. Material and Methods The retrospective study included 57 consecutive paediatric patients
(<18 years old). A percutaneous core needle biopsy (PCNB) or trephine
biopsy was performed in 53 cases, and an additional fine-needle aspiration
biopsy (FNAB) in 26 cases. In 4 cases, a stand-alone FNAB was taken.
Biopsies were performed with 0.23 T open and 1.5 T closed MRI scanners.
Statistical methods used for confidence intervals and
p-values were Wilson score method and chi-square test. Results The overall diagnostic accuracy of histologic biopsy was 0.94, with
sensitivity 0.82, specificity 1.00, positive predictive value (PPV) 1.00 and
negative predictive value (NPV) 0.92. In histological bone biopsies,
diagnostic accuracy was 0.96, with sensitivity 0.86, specificity 1.00, PPV
1.00 and NPV 0.94. The FNAB sample diagnosis was associated with the
histological diagnosis in 79% of cases. There were no major primary
complications and only a few late complications. After biopsy, 83% of the
children were ambulatory in 6 h. Anti-inflammatory drugs and paracetamol
provided satisfactory pain relief in 96% of the patients after biopsy. Most
outpatients (71%) were discharged from hospital either on the same day or
1 day later. Conclusion MRI is a technically feasible, accurate and safe guidance tool for performing
percutaneous biopsies in children.
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Affiliation(s)
- Mika Hirvonen
- Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - Juha-Jaakko Sinikumpu
- Department of Paediatric Surgery and Orthopaedics, PEDEGO Research Center, Oulu University Hospital and Oulu University, Oulu, Finland
| | - Osmo Tervonen
- Department of Radiology, Oulu University Hospital, Oulu, Finland
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11
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Practical approach for the diagnosis of biliary atresia on imaging, part 2: magnetic resonance cholecystopancreatography, hepatobiliary scintigraphy, percutaneous cholecysto-cholangiography, endoscopic retrograde cholangiopancreatography, percutaneous liver biopsy, risk scores and decisional flowchart. Pediatr Radiol 2021; 51:1545-1554. [PMID: 33974103 DOI: 10.1007/s00247-021-05034-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/23/2020] [Accepted: 02/21/2021] [Indexed: 12/11/2022]
Abstract
We aim to present a practical approach to imaging in suspected biliary atresia, an inflammatory cholangiopathy of infancy resulting in progressive fibrosis and obliteration of extrahepatic and intrahepatic bile ducts. Left untreated or with failure of the Kasai procedure, biliary atresia progresses to biliary cirrhosis, end-stage liver failure and death within the first years of life. Differentiating biliary atresia from other nonsurgical causes of neonatal cholestasis is difficult as there is no single method for diagnosing biliary atresia and clinical, laboratory and imaging features of this disease overlap with those of other causes of neonatal cholestasis. In this second part, we discuss the roles of magnetic resonance (MR) cholecystopancreatography, hepatobiliary scintigraphy, percutaneous biopsy and percutaneous cholecysto-cholangiography. Among imaging techniques, ultrasound (US) signs have a high specificity, although a normal US examination does not rule out biliary atresia. Other imaging techniques with direct opacification of the biliary tree combined with percutaneous liver biopsy have roles in equivocal cases. MR cholecystopancreatography and hepatobiliary scintigraphy are not useful for the diagnosis of biliary atresia. We propose a decisional flowchart for biliary atresia diagnosis based on US signs, including elastography, percutaneous cholecysto-cholangiography or endoscopic retrograde cholangiopancreatography and liver biopsy.
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12
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Neonatale Cholestase. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-020-01042-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Dey M, Das S, Chatterjee A, Dutta A, Ghosh R, Dasgupta J. Yield and Safety of Transjugular Versus Percutaneous Liver Biopsies in Suspected Cases of Diffuse Liver Disease and Correlation of Yield of Transjugular Liver Biopsy with Hepatic Venous Pressure Gradient. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2021. [DOI: 10.1055/s-0040-1716605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract
Background Liver biopsy is indicated in both diagnosis and prognosis of diffuse liver diseases. Conventionally, percutaneous liver biopsy (PLB) is used, as it is easily available, affordable and has a shorter procedure time, whereas transjugular liver biopsy (TJLB) is used in the setting of ascites and coagulopathy. Our aim is to evaluate the diagnostic yield of TJLB in comparison to PLB with tract embolization. Our secondary aims were to evaluate whether there is any difference in rate of major and minor complications between the two procedures and evaluate whether there is any correlation between diagnostic yield of TJLB and hepatic venous pressure gradient (HVPG).
Methods In this retrospective study, we included a total of consecutive 123 patients who underwent liver biopsy through percutaneous (n = 97) and transjugular route (n = 26). We compared the yield of the specimen based on the number of complete portal tracts (CPT).
Results There was no significant difference between mean CPT in TJLB and PLB specimens (mean CPT of TJLB and PLB were 10.9 ± 2.7 and 11.6 ±2.5, respectively [p = 0.566]). There was a moderate but significant negative correlation between the total number of CPT and HVPG in the TJLB group (Spearman’s rho − 0.58) (p = 0.002). There was no statistically significant difference in minor complication between the two procedures. Only one patient who underwent PLB developed major complication and none of TLJB procedure had any major complication.
Conclusion Yield of tissue and complication rates are comparable in TJLB and PLB groups. Yield of tissue in TJLB have intermediate but significant negative correlation with HVPG.
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Affiliation(s)
- Mousam Dey
- Division of Radiodiagnosis, Department of Intervention Radiology, Indian Institute of Liver and Digestive Sciences, Kolkata, West Bengal, India
| | - Simi Das
- Department of Radiodiagnosis, Ruby General Hospital, Kolkata, West Bengal, India
| | - Argha Chatterjee
- Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India
| | - Agnibha Dutta
- Division of General Medicine, Department of Gastroenterology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Ranajoy Ghosh
- Department of Pathology, GI Pathology, School of Digestive and Liver Diseases, IPGMER, Kolkata, West Bengal, India
| | - Jayanta Dasgupta
- Department of Gastroenterology, Indian Institute of Liver and Digestive Sciences, Kolkata, West Bengal, India
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Borquez AA, Silva-Sepulveda J, Lee JW, Vavinskaya V, Vodkin I, El-Sabrout H, Towbin R, Perry JC, Moore JW, El-Said HG. Transjugular liver biopsy for Fontan associated liver disease surveillance: Technique, outcomes and hemodynamic correlation. Int J Cardiol 2020; 328:83-88. [PMID: 33278420 DOI: 10.1016/j.ijcard.2020.11.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/17/2020] [Accepted: 11/18/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Fontan associated liver disease (FALD) is attributed to the limitations of the Fontan circulation, resulting in congestive hepatopathy. The technique and outcomes of transjugular liver biopsies (TJLB) in Fontan patients warrant definition as part of a rigorous FALD surveillance program. METHOD Four year review of patients with Fontan physiology who underwent a TJLB during surveillance catheterizations. Biopsy site, technique, histology, angiography, hemodynamics, and complications were reviewed to assess correlation of biopsy scores with simultaneously obtained catheterization hemodynamics. RESULTS 125 patients with a TJLB from 10/1/14 to 5/1/18. Median age 17 years (2-50.5). Technical success 100% (125/125), all samples diagnostic. 17% (21) accessed via the left internal jugular vein, secondary to right IJ occlusion or Heterotaxy syndrome. No patients had superior compartment obstruction preventing transjugular approach. 3.2% complication rate (4/125). Complications were early in the experience, including capsular perforation (2), renal hematoma (1) and hemobilia (1), all without long-term effect and all avoidable. After standardized entry/exit angiography was adopted, no further complications noted. There is a significant correlation between the newly described modified Ishak congestive hepatic fibrosis (ICHF) score with mean Fontan pressure, time from Fontan and cardiac index. CONCLUSIONS TJLB is an alternate method for obtaining critical FALD surveillance data, with lower complication rates that traditional techniques. Vascular anomalies in Fontan physiology appear common and warrant pre-biopsy assessment. There is a significant correlation between biopsy score, time from Fontan, mean Fontan pressure and cardiac index.
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Affiliation(s)
- Alejandro A Borquez
- San Diego School of Medicine, Department of Pediatrics, Division of Pediatric Cardiology, University of California, USA.
| | - Jose Silva-Sepulveda
- San Diego School of Medicine, Department of Pediatrics, Division of Pediatric Cardiology, University of California, USA
| | - Jesse W Lee
- San Diego School of Medicine, Department of Pediatrics, Division of Pediatric Cardiology, University of California, USA
| | - Vera Vavinskaya
- San Diego School of Medicine, Department of Pathology, University of California, USA
| | - Irine Vodkin
- San Diego School of Medicine, Department of Gastroenterology, University of California, USA
| | - Hannah El-Sabrout
- San Diego School of Medicine, Department of Pediatrics, Division of Pediatric Cardiology, University of California, USA
| | - Richard Towbin
- Department of Radiology, Phoenix Children's Hospital, USA
| | - James C Perry
- San Diego School of Medicine, Department of Pediatrics, Division of Pediatric Cardiology, University of California, USA
| | - John W Moore
- San Diego School of Medicine, Department of Pediatrics, Division of Pediatric Cardiology, University of California, USA
| | - Howaida G El-Said
- San Diego School of Medicine, Department of Pediatrics, Division of Pediatric Cardiology, University of California, USA
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Shapira-Zaltsberg G, Connolly B, Temple M, Parra DA, Amirabadi A, Amaral JG. The utility of post-biopsy ultrasonography in detecting complications after percutaneous liver biopsy in children. Pediatr Radiol 2020; 50:1717-1723. [PMID: 32789753 DOI: 10.1007/s00247-020-04783-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/13/2020] [Accepted: 07/17/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surveillance post image-guided percutaneous liver biopsy in children is variable. OBJECTIVE The aim of this study was to assess the value of 4-6-h post-procedure ultrasonography (US) in detecting post-liver-biopsy hemorrhage. MATERIALS AND METHODS This prospective study included pediatric patients who underwent US-guided percutaneous liver biopsies. All children had a US study obtained pre-procedure and one obtained 4-6 h post-procedure; US examinations were deemed positive if abnormalities were present. We also reviewed any subsequent imaging that was performed within 7 days (late imaging) at the discretion of the referring team. Changes in US findings (ΔUS) were graded by two radiologists using a descriptive non-validated scale (none, minimal, marked). Hemoglobin (Hb) levels were assessed pre-procedure and 4 h post-procedure. The diagnostic accuracy of US changes for detecting post-procedural hemorrhage was calculated based on a drop in Hb >1.5 g/dL or Hb >15% from baseline (ΔHb). We used a Kruskal-Wallis test to correlate the ΔHb with ΔUS. Association between late-imaging and post-procedure US findings was tested using a chi-square test. We included 224 biopsies. RESULTS The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of post-procedure US in detecting post-procedure hemorrhage ranged 26.3-42.1%, 72.4-93.3%, 0.22-0.42, and 0.87-0.88, respectively. No significant association was seen between the ΔHb and sonographic findings (P=0.068). No significant difference was seen in the need for late imaging between children who did and those who did not have positive US findings (P=0.814). CONCLUSION The sensitivity and PPV of post-procedure US in detecting post-procedural hemorrhage are low. Our findings do not support routine post-procedure surveillance US.
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Affiliation(s)
- Gali Shapira-Zaltsberg
- Department of Medical Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
- University of Toronto, Toronto, ON, Canada.
| | - Bairbre Connolly
- Department of Medical Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- University of Toronto, Toronto, ON, Canada
| | - Micheal Temple
- Department of Medical Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- University of Toronto, Toronto, ON, Canada
| | - Dimitri A Parra
- Department of Medical Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- University of Toronto, Toronto, ON, Canada
| | - Afsaneh Amirabadi
- Department of Medical Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- University of Toronto, Toronto, ON, Canada
| | - Joao G Amaral
- Department of Medical Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- University of Toronto, Toronto, ON, Canada
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Two-hour Observation After Liver Biopsy in Children: Clinical and Economic Outcome of a Quality Improvement Intervention. J Pediatr Gastroenterol Nutr 2020; 71:e105-e108. [PMID: 32960537 DOI: 10.1097/mpg.0000000000002821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Following percutaneous liver biopsy performed at our institution on an outpatient basis, children traditionally were observed for 4 hours then discharged after verifying a stable hematocrit level. In June 2015, we adopted a quality improvement project with shorter 2-hour observation for patients with no known risks and the hematocrit test was abandoned.The purpose of this study is to evaluate the clinical and economic outcomes of early discharge of children following liver biopsy. METHODS We analyzed data on 2 groups of children who underwent ultrasound-guided nontargeted core needle liver biopsy performed on outpatient basis. Group A (100 procedures with 4-hour postprocedural observation time and hematocrit test) was compared with group B (100 procedures with 2-hour observation without hematocrit test). RESULTS Group A consisted of 92 patients (43 boys; 49 girls) with a mean age of 11.1 years and mean weight of 52.6 kg. Group B had 92 patients (47 boys; 45 girls) with a mean age of 8.9 years and mean weight of 40.5 kg. The mean length of observation was 281 minutes (range 204-540 minutes) and 147 minutes (range 86-332 minutes) for groups A and B, respectively. The mean recovery charges were reduced by 35% per procedure in group B. The tissue obtained was sufficient for pathologic diagnosis in all procedures. There were no biopsy-related complications in either group. CONCLUSIONS Enhanced recovery with early discharge of low-risk children after 2-hour observation following percutaneous liver biopsy can be safely implemented without adversely affecting the outcome. Shorter postbiopsy observation can be cost-saving and may potentially improve patient satisfaction.
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Caruso M, Cuocolo R, Di Dato F, Mollica C, Vallone G, Romeo V, Petretta M, Liuzzi R, Mainenti PP, Iorio R, Brunetti A, Maurea S. Ultrasound, shear-wave elastography, and magnetic resonance imaging in native liver survivor patients with biliary atresia after Kasai portoenterostomy: correlation with medical outcome after treatment. Acta Radiol 2020; 61:1300-1308. [PMID: 32008344 DOI: 10.1177/0284185120902379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Biliary atresia (BA) is a rare obliterative cholangiopathy and Kasai portoenterostomy (KP) represents its first-line treatment; clinical and laboratory parameters together with abdominal ultrasound (US) are usually performed during the follow-up. Shear-wave elastography (SWE) is able to evaluate liver parenchyma stiffness; magnetic resonance imaging (MRI) has also been proposed to study these patients. PURPOSE To correlate US, SWE, and MRI imaging findings with medical outcome in patients with BA who are native liver survivors after KP. MATERIAL AND METHODS We retrospectively enrolled 24 patients. They were divided in two groups based on "ideal" (n = 15) or "non-ideal" (n = 9) medical outcome. US, SWE, and MRI exams were analyzed qualitatively and quantitatively for imaging signs suggestive of chronic liver disease (CLD). RESULTS Significant differences were found in terms of liver surface (P = 0.007) and morphology (P = 0.013), portal vein diameter (P = 0.012) and spleen size (P = 0.002) by US, liver signal intensity (P = 0.013), portal vein diameter (P = 0.010), presence of portosystemic collaterals (P = 0.042), and spleen size (P = 0.001) by MRI. The evaluation of portal vein diameter (moderate, κ = 0.44), of portosystemic collaterals (good, κ = 0.78), and spleen size (very good, κ = 0.92) showed the best agreement between US and MRI. A significant (P = 0.01) difference in liver parenchyma stiffness by SWE was also found between the two groups (cut-off = 9.6 kPa, sensitivity = 55.6%, specificity = 100%, area under the ROC curve = 0.82). CONCLUSION US, SWE, and MRI findings correlate with the medical outcome in native liver survivor patients with BA treated with KP.
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Affiliation(s)
- Martina Caruso
- Department of Advanced Biomedical Sciences, University of Naples “Federico II,” Naples, Italy
| | - Renato Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples “Federico II,” Naples, Italy
| | - Fabiola Di Dato
- Department of Translational Medical Sciences, University of Naples “Federico II,” Naples, Italy
| | - Carmine Mollica
- Institute of Bio-Structures and Bio-Imaging of the National Research Council (CNR), Naples, Italy
| | - Gianfranco Vallone
- Department of Advanced Biomedical Sciences, University of Naples “Federico II,” Naples, Italy
| | - Valeria Romeo
- Department of Advanced Biomedical Sciences, University of Naples “Federico II,” Naples, Italy
| | - Mario Petretta
- Department of Translational Medical Sciences, University of Naples “Federico II,” Naples, Italy
| | - Raffaele Liuzzi
- Institute of Bio-Structures and Bio-Imaging of the National Research Council (CNR), Naples, Italy
| | - Pier Paolo Mainenti
- Institute of Bio-Structures and Bio-Imaging of the National Research Council (CNR), Naples, Italy
| | - Raffaele Iorio
- Department of Translational Medical Sciences, University of Naples “Federico II,” Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples “Federico II,” Naples, Italy
| | - Simone Maurea
- Department of Advanced Biomedical Sciences, University of Naples “Federico II,” Naples, Italy
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Zheng M, Li J, Hu C, Tan T, Yang J, Pan J, Wu H, Li H, Lu L, Chen X, Zhang X, Xu T, Zou Y, Yang T. Liver biopsy for hepatoblastoma: a single institution's experience. Pediatr Surg Int 2020; 36:909-915. [PMID: 32583075 DOI: 10.1007/s00383-020-04702-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/PURPOSE Hepatoblastoma diagnoses require liver biopsies. We aimed to investigate factors affecting the success of liver biopsy for hepatoblastoma diagnoses. METHODS Data from patients with hepatoblastoma, including their demographic and clinical data, biopsy procedure information, pathologic diagnoses and subclassification, and surgical complications, were retrospectively reviewed. RESULTS Of 153 patients who underwent liver biopsy, 28, 93, and 31 underwent computed tomography-guided, digital subtraction angiography-guided, and ultrasound-guided percutaneous biopsies, respectively, and one underwent a laparoscopic liver biopsy. One patient developed postoperative bleeding requiring a blood transfusion. The median number of specimens collected was 3. One-hundred and forty-four (94.1%) patients' HB diagnoses were confirmed through biopsies, and 96 (62.7%) patients' HB diagnoses were subclassified. Seven surgeons and eight interventional radiologists performed the biopsies. The diagnostic success rate did not correlate with the biopsy technique or the specialist who performed the biopsy. Significantly more specimens were biopsied from the patients whose diagnoses were subclassified (3.34 ± 1.08) than from those whose diagnoses were not subclassified (2.81 ± 0.79). Surgeons tended to collect more specimens than the interventional radiologists. CONCLUSION Percutaneous liver biopsy is safe and effective for diagnosing hepatoblastoma, and its complication rate is very low. Collecting >3 pieces of tissue is preferred. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Manna Zheng
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, 510623, China
| | - Jiahao Li
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, 510623, China
| | - Chao Hu
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, 510623, China
| | - Tianbao Tan
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, 510623, China
| | - Jiliang Yang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, 510623, China
| | - Jing Pan
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, 510623, China
| | - Huiying Wu
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, 510623, China
| | - Haibo Li
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, 510623, China
| | - Lianwei Lu
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, 510623, China
| | - Xiwen Chen
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, 510623, China
| | - Xiaohong Zhang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, 510623, China
| | - Tao Xu
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, 510623, China
| | - Yan Zou
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, 510623, China
| | - Tianyou Yang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Tianhe District, Guangzhou, 510623, China.
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Setiawan CT, Landrigan-Ossar M. Pediatric Anesthesia Outside the Operating Room: Case Management. Anesthesiol Clin 2020; 38:587-604. [PMID: 32792186 DOI: 10.1016/j.anclin.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anesthesiology teams care for children in diverse locations, including diagnostic and interventional radiology, gastroenterology and pulmonary endoscopy suites, radiation oncology units, and cardiac catheterization laboratories. To provide safe, high-quality care, anesthesiologists working in these environments must understand the unique environmental and perioperative considerations and risks involved with each remote location and patient population. Once these variables are addressed, anesthesia and procedural teams can coordinate to ensure that patients and families receive the same high-quality care that they have come to expect in the operating room. This article also describes some of the considerations for anesthetic care in outfield locations.
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Affiliation(s)
- Christopher Tan Setiawan
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Anesthesiology, Children's Medical Center, 1935 Medical District Drive, Dallas, TX 75235, USA
| | - Mary Landrigan-Ossar
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA.
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Lemoine C, Melin-Aldana H, Brandt K, Mohammad S, Superina R. The evolution of early liver biopsy findings in babies with jaundice may delay the diagnosis and treatment of biliary atresia. J Pediatr Surg 2020; 55:866-872. [PMID: 32216969 DOI: 10.1016/j.jpedsurg.2020.01.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/25/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The early diagnosis of biliary atresia (BA) is associated with a better outcome after portoenterostomy. However, very early liver biopsy findings may appear atypical for BA and delay diagnosis. Repeat biopsy histology may change rapidly to show more typical features. METHODS Between 1997 and 2018, 6 babies with jaundice had more than one biopsy to establish diagnosis. Clinical and histologic data were collected. chi-Square was used for analysis (p < 0.05 significant). RESULTS Five patients had two biopsies, and one had three. Median age at first, second, and third biopsy was 40 (13-57), 68.5 (35-78), and 133 days, respectively. Biopsy readings showed no portal edema initially (0/6), but in all 6 on repeat biopsy (p = 0.001). Bile duct proliferation was seen in 6/6 final biopsies, but in only 1/6 initially (p = 0.003). All patients underwent a portoenterostomy (median age 75 days (43-113)). Median delay between initial biopsy and Kasai was 29 days (14-67). Transplant free survival (n = 5 patients) ranged from 184 to 716 days (median 309 days). One patient died before being transplanted. CONCLUSION Early biopsies may not display characteristic findings of BA, but these can appear quickly on subsequent evaluation. The interval needed to repeat a biopsy may have an adverse effect on bile drainage. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Caroline Lemoine
- Division of Transplant Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hector Melin-Aldana
- Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katherine Brandt
- Division of Transplant Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Saeed Mohammad
- Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Riccardo Superina
- Division of Transplant Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Transjugular Versus Percutaneous Liver Biopsy in Children: Indication, Success, Yield, and Complications. J Pediatr Gastroenterol Nutr 2020; 70:417-422. [PMID: 31821233 DOI: 10.1097/mpg.0000000000002587] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND/OBJECTIVE Percutaneous biopsy (PB) and transjugular liver biopsy (TJLB) are 2 main ways of obtaining liver tissue. We evaluated the indications, success rate, tissue yield, and complications of TJLB in comparison to PB in children. METHODS Electronic records of children undergoing liver biopsy (LB) were reviewed. Clinico laboratory data including indication, type of biopsy, complications, and tissue yield (length and number of complete portal tracts [CPT]) were noted. RESULTS Five hundred forty LB (indication: neonatal cholestasis [42.9%], chronic liver disease [43.7%], liver failure [3.7%], focal lesions [3.3%] and others [6.3%]) were done. Four hundred seventy-three were PB (317 boys, 14 [1--216] months) done by percussion (322 [68%]), real-time ultrasound guidance (125 [26.4%]), or plugged method [26 (5.5%)]. Sixty-seven (12.4%) were TJLB [38 boys, 140 (24--216) months], done in patients with contraindications for PB. Technical success (67/68 vs 473/473; P = 0.7) and complications (4 [6%]; vs 15 [3.3%]; P = 0.2) of TJLB and PB were similar. Major complications (0.5%) included supraventricular tachycardia (n = 1) in TJLB and hemoperitoneum (n = 2) in PB. Tissue yield of TJLB was poorer in terms of length (1.0 [0.2--2.0] vs 1.1 [0.4--2.1] cm; P < 0.001), CPT (4 [0--9] vs 5 [2--17]; P < 0.001) and adequacy for reporting (56/67 vs 459/473; P < 0.001). Biopsy yield of <6 CPT was predicted by cirrhosis at histology and TJLB. No factor identified risk of complications with LB. CONCLUSIONS LB is a safe procedure and only 12% children require TJLB because of contraindications of PB. Technical success and complications are similar but tissue yield is poorer in TJLB than PB. Presence of cirrhosis and TJLB adversely affected tissue yield.
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McDonald J, Amirabadi A, Farhat Z, Temple M, Parra D, Amaral J, Connolly B. Experience with Compressed Gelfoam Plugs in Children during Liver Biopsies and Other IR Procedures: A Retrospective Single-Center Case Series. J Vasc Interv Radiol 2019; 30:1855-1862. [DOI: 10.1016/j.jvir.2019.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 03/09/2019] [Accepted: 04/02/2019] [Indexed: 10/26/2022] Open
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Kozlovich SY, Sochet AA, Son S, Wilsey MJ. Same-Day versus Overnight Observation after Outpatient Pediatric Percutaneous Liver Biopsy: A Retrospective Cohort Study. Pediatr Gastroenterol Hepatol Nutr 2019; 22:377-386. [PMID: 31338313 PMCID: PMC6629597 DOI: 10.5223/pghn.2019.22.4.377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/03/2018] [Accepted: 10/11/2018] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Percutaneous liver biopsy (PLB), a diagnostic procedure to identify several hepatobiliary disorders, is considered safe with low incidence of associated complications. While postoperative monitoring guidelines are suggested for adults, selection of procedural recovery time for children remains at the discretion of individual operators. We aim to determine if differences exist in frequency of surgical complications, unplanned admissions, and healthcare cost for children undergoing outpatient PLB for cohorts with same-day vs. overnight observation. METHODS We performed a retrospective cohort study in children 1 month to 17 years of age undergoing ultrasound-guided PLB from January 2009 to August 2017 at a tertiary care, pediatric referral center. Cohorts were defined by postprocedural observation duration: same-day (≤8 hours) vs. overnight observation. Outcomes included surgical complications, medical interventions, unscheduled hospitalization within 7 days, and total encounter costs. RESULTS One hundred and twelve children met study criteria of which 18 (16.1%) were assigned to same-day observation. No differences were noted in demographics, anthropometrics, comorbidities, biopsy indications, or preoperative coagulation profiles. No major complications or acute hospitalizations after PLB were observed. Administration of analgesia and fluid boluses were isolated and given within 8 hours. Compared to overnight monitoring, same-day observation accrued less total costs (US $992 less per encounter). CONCLUSION Same-day observation after PLB in children appears well-tolerated with only minor interventions and complications observed within 8 hours of procedure. We recommend a targeted risk assessment prior to selection of observation duration. Same-day observation appears an appropriate recovery strategy in otherwise low-risk children undergoing outpatient PLB.
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Affiliation(s)
- Svetlana Yuryevna Kozlovich
- Department of Medicine, Pediatric Residency Program, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Anthony Alexander Sochet
- Division of Pediatric Critical Care Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Sorany Son
- Division of Pediatric Gastroenterology, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Michael John Wilsey
- Division of Pediatric Gastroenterology, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
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Perito ER, Martinez M, Turmelle YP, Mason K, Spain KM, Bucuvalas JC, Feng S. Posttransplant biopsy risk for stable long-term pediatric liver transplant recipients: 451 percutaneous biopsies from two multicenter immunosuppression withdrawal trials. Am J Transplant 2019; 19:1545-1551. [PMID: 30614623 PMCID: PMC6482080 DOI: 10.1111/ajt.15255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/20/2018] [Accepted: 12/27/2018] [Indexed: 01/25/2023]
Abstract
Although liver biopsy is the gold standard for assessing allograft health, its attendant risk has deterred its use in routine monitoring of stable liver transplant recipients during long-term follow-up. We utilized prospectively collected data on adverse events from 2 clinical trials of immunosuppression withdrawal to quantify the risk of liver biopsy in pediatric liver transplant recipients. The trials included 451 liver biopsies in 179 children. No biopsies led to bleeding requiring transfusion or intervention, suggesting a clinically significant bleeding risk of <0.8%. Complications were reported in 5.5% of biopsies (95% CI 3.6%-8.1%): 5.8% (21/363) of protocol biopsies and 4.5% (4/88) of for-cause biopsies (P = .80). Mild complications occurred in 1.8% of biopsies, moderate in 1.8%, and severe in 2.0%. The majority of complications (89%) resolved within 1 week. Six of 9 (67%) severe complications were related to biliary issues; 5 were episodes of cholangitis. Biopsy-related cholangitis occurred only in children with underlying biliary strictures. Overall, biopsy-related complications were infrequent and resolved quickly. Severe complications were rare, with occult biliary stricture as the dominant driver. Our study provides evidence for clinicians who are considering the risk vs benefit of surveillance liver biopsies in pediatric liver transplant recipients.
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Affiliation(s)
- Emily R. Perito
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Mercedes Martinez
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Yumirle P. Turmelle
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - John C. Bucuvalas
- Department of Pediatrics, Icahn School of Medicine at Mt. Sinai and the Recanti-Miller Transplant Institute, New York, NY, USA
| | - Sandy Feng
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
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Srinivasan A, Guzman AK, Rand EB, Rychik J, Goldberg DJ, Russo PA, Cahill AM. Percutaneous liver biopsy in Fontan patients. Pediatr Radiol 2019; 49:342-350. [PMID: 30506328 DOI: 10.1007/s00247-018-4311-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/06/2018] [Accepted: 11/09/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patients who have undergone the Fontan operation for palliation of congenital heart disease with single-ventricle pathophysiology are at high risk for developing progressive liver fibrosis. Pathological assessment from percutaneous liver biopsy is central to the management of Fontan-associated liver disease, but liver biopsy in this vulnerable population poses unique challenges and potential risks. OBJECTIVE This retrospective study describes our experience with percutaneous liver biopsy performed to assess changes of Fontan-associated liver disease, with particular regard to procedural outcomes. MATERIALS AND METHODS Data from liver biopsy procedure reports, pathology reports, cardiac angiography pressure measurements and laboratory values of patients with single ventricle heart disease after the Fontan operation who underwent ultrasound-guided percutaneous liver biopsy performed in interventional radiology at a pediatric tertiary care center during a 3-year period were retrospectively analyzed. RESULTS Sixty-eight liver biopsies were performed in 67 patients (mean age: 20.2 years, range: 7.2-39 years). The technical success rate was 100%, and tissue was adequate for assessing liver disease in 100% of the procedures, including biopsies performed with a single pass. Anticoagulation was routinely suspended before biopsy, and no cardiac complications were encountered due to this suspension. A coaxial biopsy system using an 18-gauge (G) full-core instrument through a 17-G introducer trocar was most commonly used, in 41/68 cases (60%). The most common trough length was 2.3 cm, used in 37 cases (54%). One pass was made in 27 procedures (40%) and two passes in 30 (44%); tract embolization with gelatin sponge was performed in 52 (76%). The only complication was hemorrhage, which occurred in 5/68 (7.4%) of the biopsies, minor in four (5.9%) and major in one (1.5%) -- similar to rates reported for liver biopsy in non-Fontan patients. Hemorrhage had a delayed presentation in three of these five cases. Immediate post-biopsy hemoglobin decrease of ≥2 mg/dL showed a low sensitivity for hemorrhage. The mean Fontan pressure measured during cardiac angiography was 13.8 mmHg, and shunt pressures were not associated with an increased risk of hemorrhage. CONCLUSION Percutaneous liver biopsy in Fontan patients can be performed safely with high technical success rates and without increased complication rates. Meticulous technique and close observation are recommended to reduce post-biopsy complications. The degree of right heart pressure elevation was not associated with hemorrhage.
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Affiliation(s)
- Abhay Srinivasan
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Radiology 3NW47, Philadelphia, PA, 19104, USA. .,Children Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, USA.
| | - Anthony K Guzman
- Children Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, USA
| | - Elizabeth B Rand
- Children Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, USA.,Department of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jack Rychik
- Children Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, USA.,Department of Cardiology, University of Pennsylvania Peralman School of Medicine, Philadelphia, PA, USA
| | - David J Goldberg
- Children Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, USA.,Department of Cardiology, University of Pennsylvania Peralman School of Medicine, Philadelphia, PA, USA
| | - Pierre A Russo
- Children Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, USA.,Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anne Marie Cahill
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Radiology 3NW47, Philadelphia, PA, 19104, USA.,Children Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, USA
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Midia M, Odedra D, Shuster A, Midia R, Muir J. Predictors of bleeding complications following percutaneous image-guided liver biopsy: a scoping review. Diagn Interv Radiol 2019; 25:71-80. [PMID: 30644369 PMCID: PMC6339629 DOI: 10.5152/dir.2018.17525] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/08/2018] [Accepted: 07/02/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE Percutaneous tissue biopsy is a mainstay of diagnostic and interventional radiology, providing a minimally invasive method for diagnosing malignant and benign disease. The purpose of this review was to collect and summarize the best available evidence regarding the risk factors associated with bleeding complications in image-guided liver biopsy. METHODS A literature review was performed, searching Medline, EMBASE, CINAHL, the Cochrane Library, the National Institute for Health and Care Excellence (NICE) and Canadian Agency for Drugs and Technology in Health (CADTH) databases for any studies evaluating bleeding complications in image-guided liver biopsy. A total of 68 articles, published between January 1994 and April 2015, were reviewed in full, with 34 ultimately eligible for inclusion in the review. RESULTS Bleeding of any kind occurred in up to 10.9% of image-guided liver biopsies, with major bleeding episodes ranging from 0.1% to 4.6% and minor bleeding events occurring in up to 10.9% of biopsies. The overall rate of bleeding was, however, found to be less than 2%. Several risk factors (patient, operator, and procedure-related) were identified as potentially indicative of an increased risk of post-biopsy bleeding. Patient-related risk factors included patient age (>50 years or <2 years), inpatient status (8/12 vs. 4/12, P < 0.001), comorbidities and/or concurrent diagnoses and coagulation status (rate of bleeding was 3.3% for international normalized ratio [INR] 1.2-1.5 vs. 7.1% for INR >1.5, P < 0.001). There was no consensus on impact of operator experience (>200 biopsies/year vs. <50/year) on post-biopsy bleeding rate. Procedure-related risk factors included needle size (cutting biopsy vs. fine needle aspiration, P < 0.001) and the presence of a patent track on post-biopsy ultrasound (P < 0.001). Lastly there was no difference found between targeted vs. nontargeted biopsies and number of needle passes. CONCLUSION Reported rate of post-biopsy bleeding ranges between 0% and 10.9%, although the vast majority of studies reported bleeding rates under 2%. Several patient, operator, and procedure-related risk factors are associated with a higher risk of bleeding following liver biopsy.
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Affiliation(s)
- Mehran Midia
- From the Department of Radiology (M.M. , D.O.), McMaster University School of Medicine, Hamilton, ON, Canada; Department of Radiology (A.S.), Thunder Bay Health Sciences, Thunder Bay, ON, Canada; St Francis Health (R.M.), Topeka, Kansas, USA; Motion Research (J.M.), Ancaster, ON, Canada
| | - Devang Odedra
- From the Department of Radiology (M.M. , D.O.), McMaster University School of Medicine, Hamilton, ON, Canada; Department of Radiology (A.S.), Thunder Bay Health Sciences, Thunder Bay, ON, Canada; St Francis Health (R.M.), Topeka, Kansas, USA; Motion Research (J.M.), Ancaster, ON, Canada
| | - Anatoly Shuster
- From the Department of Radiology (M.M. , D.O.), McMaster University School of Medicine, Hamilton, ON, Canada; Department of Radiology (A.S.), Thunder Bay Health Sciences, Thunder Bay, ON, Canada; St Francis Health (R.M.), Topeka, Kansas, USA; Motion Research (J.M.), Ancaster, ON, Canada
| | - Ramin Midia
- From the Department of Radiology (M.M. , D.O.), McMaster University School of Medicine, Hamilton, ON, Canada; Department of Radiology (A.S.), Thunder Bay Health Sciences, Thunder Bay, ON, Canada; St Francis Health (R.M.), Topeka, Kansas, USA; Motion Research (J.M.), Ancaster, ON, Canada
| | - Jeffrey Muir
- From the Department of Radiology (M.M. , D.O.), McMaster University School of Medicine, Hamilton, ON, Canada; Department of Radiology (A.S.), Thunder Bay Health Sciences, Thunder Bay, ON, Canada; St Francis Health (R.M.), Topeka, Kansas, USA; Motion Research (J.M.), Ancaster, ON, Canada
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Chapin CA, Mohammad S, Bass LM, Taylor SA, Kelly S, Alonso EM. Liver Biopsy Can Be Safely Performed in Pediatric Acute Liver Failure to Aid in Diagnosis and Management. J Pediatr Gastroenterol Nutr 2018; 67:441-445. [PMID: 30028827 DOI: 10.1097/mpg.0000000000002096] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Liver biopsy can be a valuable tool to help determine the etiology of pediatric acute liver failure (PALF), but is often not performed due to safety concerns. The primary aim was to describe the incidence of major complications after liver biopsy performed in the setting of PALF. METHODS Medical records from 2006 to 2016 were reviewed. Patients age 0 to 17 years, who met criteria for PALF, and had a liver biopsy performed while their international normalized ratio (INR) was ≥1.5 were included. RESULTS A total of 26 cases of liver biopsy in the setting of PALF were identified. The majority (n = 22, 85%) of patients had primary liver disease. Most biopsies (n = 17, 65%) were performed by the transjugular route, with 5 (19%) performed percutaneously under ultrasound guidance and 4 (15%) during a surgical procedure. Median INR before biopsy was 2.1 (IQR = 1.73-2.9). Blood products were given before or during the procedure in 23 (88%) cases. One patient (3.8%) had a major complication of biopsy-associated bleeding requiring a blood transfusion. An additional 3 patients had a hemoglobin decrease of 2.1 to 2.9 g/dL post-biopsy that was attributed to the procedure but no interventions were necessary. Biopsy results contributed to establishing a diagnosis in 62% (n = 16) of cases, and influenced treatment decisions in 9 of those cases. CONCLUSIONS Liver biopsy is safe in the majority of patients with PALF and associated with infrequent major complications. Clinicians should consider performing liver biopsy in this setting, especially when the transjugular approach is feasible, since findings may guide diagnosis and therapy.
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Affiliation(s)
- Catherine A Chapin
- Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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Comparison of Transjugular Liver Biopsy and Percutaneous Liver Biopsy With Tract Embolization in Pediatric Patients. J Pediatr Gastroenterol Nutr 2018; 67:180-184. [PMID: 29509634 DOI: 10.1097/mpg.0000000000001951] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE The aim of the study was to compare safety and efficacy of transjugular liver biopsy (TJLB) and percutaneous liver biopsy (PLB) with tract embolization in pediatric patients with liver disease. MATERIALS AND METHODS TJLB and PLB between December 2009 and October 2015 were retrospectively reviewed. Primary endpoints were adequate sampling and complication rate. Patient age, weight, coagulation factors, ascites, blood transfusions, adequacy of biopsy sample, number of biopsy samples, and complications were compared. RESULTS There were 39 TJLB (average age 10.6 years) and 120 PLB (average age 7.1 years) (P value <0.05). Average weight was 40.2 kg for TJLB and 26.8 kg for PLB (P value <0.05). Average platelets were 155 for TJLB and 252 for PLB (P value <0.05). Average international normalized ratio was 1.7 for TJLB and 1.3 for PLB (P value <0.05). Mean postbiopsy hematocrit decrease was 0.8 and 0.9, for TJLB and PLB, respectively. Mean postbiopsy hemoglobin decrease was 0.3 in both groups. Number of core biopsy samples was 4.5 and 4.3, for TJLB and PLB, respectively. There was 1 biopsy yielding insufficient sample in each group. TJLB had 1 (2.6%) complication of supraventricular tachycardia. PLB had 4 (3.3%) complications, with 1 hemoperitoneum, 1 hypotension, 1 patient with decreased hemoglobin, and 1 patient with bilious drainage from the biopsy site. CONCLUSIONS TJLB and PLB with gelatin sponge pledget tract embolization are both safe and effective for the diagnosis of hepatic disease in pediatric patients. To avoid radiation, PLB may be considered as first-line approach in the pediatric population, even in the setting of coagulopathy.
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Almeida P, Schreiber RA, Liang J, Mujawar Q, Guttman OR. Clinical Characteristics and Complications of Pediatric Liver Biopsy: A Single Centre Experience. Ann Hepatol 2018; 16:797-801. [PMID: 28809725 DOI: 10.5604/01.3001.0010.2809] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Percutaneous liver biopsy (LB) is the gold standard method for evaluation and management of patients with liver disease. The purpose of this study was to characterize pediatric patients undergoing LB at British Columbia Children's Hospital, and to determine the rate and timing of complications following the procedure. MATERIAL AND METHODS The medical records of all pediatric patients who underwent LB during a six-year retrospective study were reviewed to collect demographic and procedure-related data. RESULTS 223 LBs were performed, and 179 of these biopsies were percutaneous or transjugular. Elevated liver enzymes and cholestasis together accounted for almost 70% of the indications for LB, and the histological analysis of liver tissue yielded a specific diagnosis in 89 % of the cases. There were no deaths and no major complications related to LB. The most frequent minor complication was pain (59% of LBs) and the other complications were bleeding-related and classified as minor. The vast majority of complications (88%) were recognized within 8 h of the LB. CONCLUSIONS LB is a valuable and safe procedure in pediatric patients with a low rate of complications. Pediatric patients can be discharged home safely should no complications occur within the first 8-12 h after the procedure.
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Affiliation(s)
- Patricia Almeida
- Hepatology and Nutrition, BC Children's Hospital Division of Pediatric Gastroenterology
| | - Richard A Schreiber
- Hepatology and Nutrition, BC Children's Hospital Division of Pediatric Gastroenterology
| | - Jennifer Liang
- Hepatology and Nutrition, BC Children's Hospital Division of Pediatric Gastroenterology
| | - Quais Mujawar
- University of Manitoba, Winnipeg, MB, Canada Department of Pediatrics and Child Health
| | - Orlee R Guttman
- Hepatology and Nutrition, BC Children's Hospital Division of Pediatric Gastroenterology
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Ultrasound-guided Liver Biopsies in Children: A Single-center Experience and Risk Factors for Minor Bleeding. J Pediatr Gastroenterol Nutr 2017; 65:137-140. [PMID: 28394846 DOI: 10.1097/mpg.0000000000001601] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aim of the study was to analyze the institution's experience in ultrasound-guided liver biopsies performed on children and identify risk factors for complications, following a previous study performed in our institution. METHODS Retrospective analysis of a consecutive series of ultrasound-guided pediatric liver biopsies, between 2011 and 2016. Demographic and anthropometric data, biopsy indications, international normalized ratio (INR) and platelet count, biopsy technique, complications, and pathologic outcomes were recorded. RESULTS A total of 228 procedures were performed on 203 children with a median age of 9.25 years (range: 0.08-18.42): 107 girls (47%) and 121 boys (53%). One hundred twenty-seven biopsies were performed on transplanted livers (55.7%) and 101 on native livers (44.3%). There were 27 cases with immediate complications (11.84%), all due to minor bleeding. There were no major complications. Increasing needle passes were shown to be a reliable predictor for bleeding (P = 0.0023), whereas transplanted livers predicted protection against bleeding (P = 0.0007). Age younger than 3 years, bodyweight <16 kg, platelet count <70 g/L and INR >1.25 revealed association with increased bleeding incidence, but no predictive value. CONCLUSION Ultrasound-guided liver biopsies in pediatric age are a safe procedure with a high diagnostic yield. Increasing the number of needle passes predicts a higher incidence of minor bleeding. Other factors to account for minor bleeding risk may include age younger than 3 years, bodyweight <16 kg, platelet count <70 G/L, and INR >1.25. Transplanted livers present a lower bleeding risk.
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Hayatghaibi S, Ashton D, Cleveland H, Kukreja K. Limited Post-observation Period in Pediatric Outpatient Ultrasound-Guided Liver Biopsies. Cardiovasc Intervent Radiol 2017; 40:1899-1903. [DOI: 10.1007/s00270-017-1720-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/31/2017] [Indexed: 12/18/2022]
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NASPGHAN Clinical Practice Guideline for the Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease in Children: Recommendations from the Expert Committee on NAFLD (ECON) and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). J Pediatr Gastroenterol Nutr 2017; 64:319-334. [PMID: 28107283 PMCID: PMC5413933 DOI: 10.1097/mpg.0000000000001482] [Citation(s) in RCA: 607] [Impact Index Per Article: 86.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a highly prevalent chronic liver disease that occurs in the setting of insulin resistance and increased adiposity. It has rapidly evolved into the most common liver disease seen in the pediatric population and is a management challenge for general pediatric practitioners, subspecialists, and for health systems. In this guideline, the expert committee on NAFLD reviewed and summarized the available literature, formulating recommendations to guide screening and clinical care of children with NAFLD.
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Guideline for the Evaluation of Cholestatic Jaundice in Infants: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 2017; 64:154-168. [PMID: 27429428 DOI: 10.1097/mpg.0000000000001334] [Citation(s) in RCA: 274] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cholestatic jaundice in infancy affects approximately 1 in every 2500 term infants and is infrequently recognized by primary providers in the setting of physiologic jaundice. Cholestatic jaundice is always pathologic and indicates hepatobiliary dysfunction. Early detection by the primary care physician and timely referrals to the pediatric gastroenterologist/hepatologist are important contributors to optimal treatment and prognosis. The most common causes of cholestatic jaundice in the first months of life are biliary atresia (25%-40%) followed by an expanding list of monogenic disorders (25%), along with many unknown or multifactorial (eg, parenteral nutrition-related) causes, each of which may have time-sensitive and distinct treatment plans. Thus, these guidelines can have an essential role for the evaluation of neonatal cholestasis to optimize care. The recommendations from this clinical practice guideline are based upon review and analysis of published literature and the combined experience of the authors. The committee recommends that any infant noted to be jaundiced after 2 weeks of age be evaluated for cholestasis with measurement of total and direct serum bilirubin, and that an elevated serum direct bilirubin level (direct bilirubin levels >1.0 mg/dL or >17 μmol/L) warrants timely consideration for evaluation and referral to a pediatric gastroenterologist or hepatologist. Of note, current differential diagnostic plans now incorporate consideration of modern broad-based next-generation DNA sequencing technologies in the proper clinical context. These recommendations are a general guideline and are not intended as a substitute for clinical judgment or as a protocol for the care of all infants with cholestasis. Broad implementation of these recommendations is expected to reduce the time to the diagnosis of pediatric liver diseases, including biliary atresia, leading to improved outcomes.
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Mogahed EA, Mansy YA, Al Hawi Y, El-Sayed R, El-Raziky M, El-Karaksy H. Blind percutaneous liver biopsy in infants and children: Comparison of safety and efficacy of percussion technique and ultrasound assisted technique. Arab J Gastroenterol 2016; 17:168-175. [PMID: 27914885 DOI: 10.1016/j.ajg.2016.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 10/25/2016] [Accepted: 10/30/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS Liver biopsy remains the most reliable method to diagnose various hepatic disorders in children. We aimed to assess the technical success and complication rate of ultrasound (US) assisted percutaneous liver biopsy versus transthoracic percussion guided technique in paediatrics. PATIENTS AND METHODS This randomized controlled study included all cases performing liver biopsy at Paediatric Hepatology Unit, Cairo University Paediatric Hospital over 12months. RESULTS Patients were 102 cases; 62 were males, with age range 18days to 12years. Fifty seven procedures were done using the percussion guided technique and 45 cases were US assisted. The total number of complicated biopsies was 14 (13.7%), with more serious complications occurring in the percussion group. Complications were more frequent with younger age, lower platelet count, number of passes and occurrence of hypotension. CONCLUSION US assisted percutaneous liver biopsy, although more costly, but may be safer to perform particularly in younger age.
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Affiliation(s)
- Engy A Mogahed
- Department of Paediatrics, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yasmeen A Mansy
- Department of Paediatrics, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yasmeen Al Hawi
- Department of Paediatrics, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rokaya El-Sayed
- Department of Paediatrics, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mona El-Raziky
- Department of Paediatrics, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hanaa El-Karaksy
- Department of Paediatrics, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
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Chaudry G. Pediatric interventional radiology. SA J Radiol 2016. [DOI: 10.4102/sajr.v20i1.940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Paediatric interventional radiology (IR) is a rapidly developing subspecialty, seeking to meet the increasing demand for image-guided minimally invasive procedures. The wide range of procedures performed and the conditions treated reflect the varying ages and complexity of the patient population. This article reviews the various interventional procedures performed and the unique challenges faced in paediatric IR. Conditions, such as vascular anomalies, that are primarily treated by paediatric interventional radiologists are highlighted. The requirements for establishing a paediatric IR practice are reviewed, as are the challenges facing the future development of the specialty.Keywords: pediatric interventional radiology
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Abstract
OBJECTIVE Determine factors that increase the risk of bleeding after liver biopsy. METHODS Retrospective review of radiology and clinical databases from Jan 2008 to Jun 2014 revealed 847 patients with liver biopsy. Of these, 154 (group I) had targeted biopsy of focal lesion and 142 (group 2) had random core biopsy for diffuse liver disease. The rest of the patients were excluded due to insufficient post-biopsy data. Data including pre-biopsy laboratory results, history of transfusion, and biopsy complications were recorded in the study cohort. After review of initial results, a "Risk Score" for bleeding was created using platelet count, INR, estimated glomerular filtration rate (eGFR), and suspicion of malignancy. Zero point was given for normal laboratory results or absence of malignancy. One point was given for mildly abnormal laboratory values or presence of malignancy. Severe biochemical abnormalities, e.g., INR > 2.0, eGFR < 30 mL/min, or platelet count ≤ 50 × 10(9)/L were given two points each. The "Risk Score" was made of adding individual points. RESULTS Of 847 patients queried by retrospective database search, 296 had adequate records for the period of 2 weeks prior to biopsy to 4 weeks after biopsy. The remaining patients had liver biopsy as outpatients and probably did not have bleeding complications but no electronic records were found to confirm this. 25 (8.4%) of 296 patients had post-biopsy bleeding, with incidences of 11.7% and 4.9% in groups 1 and 2 (p = 0.04). On logistic regression analysis, the only significant predictor of bleeding was the "Risk Score" (p = 0.01, odds ratio 4.6). There was substantial overlap in INR, and platelet count in bleeders vs. non-bleeders. Pre-biopsy fresh frozen plasma or platelet concentrate infusions did not reduce the risk of bleeding. CONCLUSION INR and platelet count are not an independent risk factors for post-biopsy bleeding. A "Risk Score" made up of individual risk factors was a better predictor of bleeding.
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Kose S, Ersan G, Tatar B, Adar P, Sengel BE. Evaluation of Percutaneous Liver Biopsy Complications in Patients with Chronic Viral Hepatitis. Eurasian J Med 2015; 47:161-4. [PMID: 26644763 DOI: 10.5152/eurasianjmed.2015.107] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Liver biopsy is still the gold standard for the determination of liver fibrosis and necroinflammatory activity. It is an invasive method and may lead to severe complications. The aim of this study was to determine the evaluation of percutaneous liver biopsy complications in patients with chronic viral hepatitis. MATERIALS AND METHODS 1165 patients, who were followed with the diagnosis of chronic viral hepatitis and who were applied percutaneous liver biopsy between January 2000 and February 2013 at the out-patient clinic of Infectious Diseases and Clinical Microbiology, were included in the study. RESULTS Of 1165 patients who underwent liver biopsy, 196 (86 male, 110 female) were diagnosed with chronic hepatitis C, 969 (559 male, 410 female) were diagnosed with chronic hepatitis B. The mean age was 43.3 and 55.4% were male. 11% of the patients were diagnosed with chronic renal failure and underwent haemodialysis. Minor complication rate was about 20% (severe pain required usage of analgesic drugs in 19.8%, abdominal pain in 22.6%) whereas major complication rate was 1.15% (pneumothorax in 0.17%, heamobilia in 0.08%, hematoma in 0.9%). We did not observe severe complications such as fever, abscess, anaphylaxis, bacteraemia, organ perforations, sepsis or death. CONCLUSION Despite being an invasive procedure, percutaneous liver biopsy can be considered a safe method because of the low rates of severe complications observed in our patients.
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Affiliation(s)
- Sukran Kose
- Clinic of Infectious Diseases and Clinical Microbiology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Gursel Ersan
- Clinic of Infectious Diseases and Clinical Microbiology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Bengu Tatar
- Clinic of Infectious Diseases and Clinical Microbiology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Pelin Adar
- Clinic of Infectious Diseases and Clinical Microbiology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Buket Erturk Sengel
- Clinic of Infectious Diseases and Clinical Microbiology Clinic, Tekirdağ Public Hospital, Tekirdağ, Turkey
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Honar N, Jooya P, Haghighat M, Imanieh MH, Dehghani SM, Zahmatkeshan M, Javaherizadeh H. Complications of blind versus ultrasound-guided percutaneous liver biopsy in children. Arab J Gastroenterol 2015; 16:90-3. [PMID: 26526508 DOI: 10.1016/j.ajg.2015.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 05/23/2015] [Accepted: 09/28/2015] [Indexed: 02/05/2023]
Affiliation(s)
- Naser Honar
- Gastroenterohepatology Research Center, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parisa Jooya
- Gastroenterohepatology Research Center, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmood Haghighat
- Gastroenterohepatology Research Center, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hadi Imanieh
- Gastroenterohepatology Research Center, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Mohsen Dehghani
- Gastroenterohepatology Research Center, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhgan Zahmatkeshan
- Gastroenterohepatology Research Center, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hazhir Javaherizadeh
- Gastroenterohepatology Research Center, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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Predictors of diagnostic success in image-guided pediatric soft-tissue biopsies. Pediatr Radiol 2015; 45:1529-34. [PMID: 25958250 DOI: 10.1007/s00247-015-3364-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/20/2015] [Accepted: 04/09/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Image-guided percutaneous core needle biopsy (PCNB) of soft-tissue lesions is a minimally invasive technique that can provide a definitive diagnosis for treatment. Anatomical and age considerations in children require judicious use of safe percutaneous biopsy techniques. There are, however, limited data on the determinants of diagnostic yield in soft-tissue lesions in this population. OBJECTIVES To assess lesion-related and technical factors that affect diagnostic yield and safety in PCNB of pediatric soft-tissue lesions. MATERIALS AND METHODS This was a retrospective cohort study of 205 PCNB performed from January 2000 to July 2014. Diagnostic yield and its associations with technical and lesion-related factors were evaluated using bivariate analysis. RESULTS The mean patient age was 11.1 ± 6.9 years (interquartile range [IQR]: 4.3-16 years). Ultrasound guidance alone was used in 91% of cases. The mean number of passes was 7.5 ± 3.2 (IQR: 5-9 passes) per case. The overall diagnostic yield was 75% and the overall accuracy was 88%. Performing fewer than four passes was associated with a nondiagnostic biopsy (P = 0.001). There were no lesion or other technical factors that predicted a diagnostic biopsy. There were two complications (1%) over 14 years. CONCLUSION Image-guided PCNB is a safe and effective means for the diagnosis of pediatric soft-tissue abnormalities. Aside from performing at least four passes, our data show no technical or lesion-related factors that increase diagnostic yield in pediatric PCNB of soft-tissue lesions.
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Dillman JR, Heider A, Bilhartz JL, Smith EA, Keshavarzi N, Rubin JM, Lopez MJ. Ultrasound shear wave speed measurements correlate with liver fibrosis in children. Pediatr Radiol 2015; 45:1480-8. [PMID: 25851300 PMCID: PMC6557376 DOI: 10.1007/s00247-015-3345-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/09/2015] [Accepted: 03/18/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Little published research has shown the relationship between noninvasive US shear wave speed (SWS) measurements and degree of liver fibrosis as established by percutaneous biopsy in children. OBJECTIVE To assess the relationship between liver US shear wave speed (SWS) measurements and parenchymal fibrosis in children. MATERIALS AND METHODS Sixty-two children (0-18 years old) with known or suspected liver disease underwent same-day US shear wave elastography (SWE) and clinically ordered percutaneous core needle biopsy. SWE was performed just before the liver biopsy in the area targeted for sampling, using an Acuson S3000 US system with a 9L4 transducer; six SWS measurements were acquired using Virtual Touch Quantification (VTQ) and Virtual Touch IQ (VTIQ) modes. Biopsy specimens were scored for histological fibrosis and inflammation. Bivariate relationships were assessed using Pearson correlation, while multiple linear regression analysis was used to establish the relationship between SWS and predictor variables. Receiver operating characteristic (ROC) curves were created to assess the abilities of VTQ and VTIQ to discern low vs. high liver fibrosis (histological fibrosis scores 0-2 vs. 3-6). RESULTS There were significant positive correlations between liver histological fibrosis score and VTQ (n = 49) and VTIQ (n = 48) mean shear wave speed measurements (r = 0.68 and r = 0.73; P-values <0.0001). There also were significant positive correlations between liver histological inflammation score and VTQ and VTIQ mean shear wave speed measurements (r = 0.47 and r = 0.44, and P = 0.0006 and P = 0.0016, respectively). For VTQ, both histological fibrosis (P < 0.0001) and inflammation (P = 0.04) scores were significant predictors of shear wave speed (model adjusted R (2) = 0.49). For VTIQ, only histological fibrosis score (P < 0.0001) was a significant predictor of shear wave speed (model adjusted R (2) = 0.56). ROC areas under the curve were 0.84 and 0.86 for VTQ and VTIQ, respectively. CONCLUSION Liver US shear wave speed measurements increase with increasing parenchymal fibrosis in children.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, University of Michigan Health System, Section of Pediatric Radiology, C. S. Mott Children's Hospital, 1540 E. Hospital Drive, Ann Arbor, MI, 48109, USA,
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Delvin E, Patey N, Dubois J, Henderson M, Lévy É. Pediatric Non-Alcoholic Fatty Liver Disease. J Med Biochem 2015; 34:3-12. [PMID: 28356817 PMCID: PMC4922334 DOI: 10.2478/jomb-2014-0059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
The rapidly increasing prevalence of childhood obesity and its associated co-morbidities such as hypertriglyceridemia, hyper-insulinemia, hypertension, early atherosclerosis, metabolic syndrome, and non-alcoholic fatty liver disease are major public health concerns in many countries. Therefore the trends in child and adolescent obesity should be closely monitored over time, as in the near future, we may anticipate a major increase of young adults with the stigmata of the metabolic syndrome, and of the related non-alcoholic fatty liver disease (NAFLD), that may lead to non-alcoholic steatohepatitis.
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Affiliation(s)
- Edgard Delvin
- Departement of Biochemistry, University of Montreal, Montreal, Quebec, Canada
- CHU Sainte-Justine Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Natasha Patey
- CHU Sainte-Justine Research Center, University of Montreal, Montreal, Quebec, Canada
- Department of Pathology, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
- Department of Cell Biology and Pathology, University of Montreal, Montreal, Quebec, Canada
| | - Josée Dubois
- CHU Sainte-Justine Research Center, University of Montreal, Montreal, Quebec, Canada
- Department of Radiology, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Melanie Henderson
- CHU Sainte-Justine Research Center, University of Montreal, Montreal, Quebec, Canada
- Divisions of Genetics and Endocrinology, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Émile Lévy
- CHU Sainte-Justine Research Center, University of Montreal, Montreal, Quebec, Canada
- Department of Nutrition, University of Montreal, Montreal, Quebec, Canada
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Murphy FB, Walls G, Tridandapani S, Ibraheem O, Bowen M, Bressler S, Yamada K, Small W. Comparison of image-guided nonfocal hepatic biopsies performed by physicians and nurse midlevel providers. J Am Coll Radiol 2014; 11:1059-63. [PMID: 24889475 DOI: 10.1016/j.jacr.2014.03.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 03/30/2014] [Indexed: 12/17/2022]
Abstract
Image-guided hepatic biopsies have been performed safely and accurately for a number of years. The advantages of sonographic or CT guidance in avoiding major vital structures, such as large vessels, the gallbladder, or pleura, have been confirmed many times. However, the safety and accuracy of certified nurse practitioners' performing these biopsies have not been described. The authors describe a retrospective review of 418 image-guided hepatic biopsies that demonstrated no significant difference in accuracy or complication rates between biopsies performed by certified nurse practitioners and those performed by radiologists in a single-institution, multihospital academic setting. Appropriately trained advanced practice providers can perform image-guided hepatic biopsies safely and accurately.
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Affiliation(s)
- Frederick B Murphy
- Department of Radiology and Imaging Sciences, The Emory University School of Medicine, Atlanta, Georgia.
| | - Gail Walls
- Department of Radiology and Imaging Sciences, The Emory University School of Medicine, Atlanta, Georgia
| | - Srini Tridandapani
- Department of Radiology and Imaging Sciences, The Emory University School of Medicine, Atlanta, Georgia
| | - Oluwayemisi Ibraheem
- Department of Radiology and Imaging Sciences, The Emory University School of Medicine, Atlanta, Georgia
| | - Michael Bowen
- Department of Radiology and Imaging Sciences, The Emory University School of Medicine, Atlanta, Georgia
| | - Suzanne Bressler
- Department of Radiology and Imaging Sciences, The Emory University School of Medicine, Atlanta, Georgia
| | - Kei Yamada
- Department of Radiology and Imaging Sciences, The Emory University School of Medicine, Atlanta, Georgia
| | - William Small
- Department of Radiology and Imaging Sciences, The Emory University School of Medicine, Atlanta, Georgia
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