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[Experience in patients with suspected chronic liver disease and contraindication for percutaneous biopsy using
A C Maciel1, S G de Barros, D P Tarasconi
1Serviço de Radiologia da Irmandade da Santa Casa de Misericórdia de Porto Alegre, Hospital de Clínicas de Porto Alegre, RS.
Purpose:
This work aimed at introducing the transjugular liver biopsy technique oriented by radiologic methods in our hospitals. This technique is indicated for obtaining histopathologic diagnosis in patients clinically and laboratory suspected of having chronic liver disease with contraindications to percutaneous liver biopsy.
Methods:
Liver biopsy was obtained with a modified Ross needle through the right jugular vein and right hepatic vein under fluoroscopic control.
Results:
Transjugular liver biopsy was attempted for 39 patients, liver tissue obtained en 32 and histopathologic diagnosis in 25 (64.1%). In 11 patients (28.2%) there was agreement between the diagnoses established before and after biopsy, however, in 14 patients (35.9%), there was disagreement. The yield of diagnosis was low when patients were suspected for cirrhosis. The procedure was well tolerated by the majority of patients. Nonetheless, 1 presented intra-abdominal bleeding and required immediate surgery to control retroperitoneal hemorrhage.
Conclusions:
Transjugular liver biopsy is useful for the histopathologic diagnosis of patients with chronic liver diseases whenever the percutaneous route is contraindicated. In this series we obtained histopathologic diagnosis for 64.1% of the subjects studied. Patients suspected of having cirrhosis had a low yield of histopathologic diagnosis (50%) when compared to subjects without clinical evidence for cirrhosis (78.9%). The technique is rather complex, and can cause serious complications. This, it should be performed in reference centers in radiology and hepatology.