[The liver biopsy: a tool for the diagnosis in chronic cholestasis in pediatric liver disease]

Protracted cholestasis of infancy is a clinical and pathological manifestation of several injuries to the liver and biliary tract. Function liver biopsy is a well stablished procedure for cholestasis differential diagnosis which allows to guide therapeutics. In this review the author describe and analyse biopsy advantages and mention some of the technical and methodological considerations which permit to improve histological diagnosis. Preliminary results of a study of 110 punction liver biopsies from patients with neonatal protracted cholestasis are presented. In 42 patients a biliary atresia was found and a correlation with surgical findings was done. A 94% sensitivity, and 97% specificity for histological diagnosis was found. In contrast, gammagraphic diagnosis had a 100% sensitivity and only 77.7% specificity. In 16 patients, from a total of 38 with a final diagnosis of neonatal hepatitis, a biliary obstruction was initially suspected. In these 16 patients, a punction liver biopsy was not considered before the surgical exploration. However, a clear histological picture of neonatal hepatitis was found in the wedge liver biopsy obtained during abdominal laparotomy. This data confirms punction liver biopsy utility even if a highly suggestive clinical picture of biliary obstruction is found. It also allows to avoid unnecessary exploratory laparatomy.