Outpatient Liver Biopsy in Children: Safety, Feasibility, and Economic Impact
Rishi Bolia1, Judy Matta, Rohan Malik
1Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Australia.
Insights
Outpatient liver biopsies are safe for children if an 8-hour observation period is implemented. This pediatric liver biopsy study found a low complication rate, suggesting cost savings and improved resource allocation.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Interventional Procedures
Background:
- Liver biopsy is crucial for diagnosing pediatric liver diseases.
- Current recommendations for outpatient pediatric liver biopsy safety and feasibility are lacking.
- Percutaneous liver biopsy is a common procedure in adults.
Purpose of the Study:
- To evaluate the safety and feasibility of outpatient percutaneous liver biopsy in children.
- To identify the complication rate and types associated with pediatric liver biopsy.
- To assess the potential benefits of outpatient liver biopsy in children, including cost savings.
Main Methods:
- Retrospective review of pediatric percutaneous liver biopsies performed between January 2005 and June 2015.
- Analysis of patient demographics, indications for biopsy, procedural details, and complication rates.
- Evaluation of the timing of complication identification and factors influencing complication occurrence.
Main Results:
- A total of 626 biopsies were performed on 497 pediatric patients.
- The overall complication rate was 4.8% (30 biopsies), with subcapsular hematoma being the most common (46.7% of complications).
- No factors such as approach, needle size, or number of passes were associated with increased complication rates. Bleeding complications were not linked to the international normalized ratio.
Conclusions:
- Outpatient percutaneous liver biopsy can be performed safely in children with an 8-hour observation period.
- Implementing outpatient liver biopsies could lead to significant cost savings and better bed utilization.
- This study supports the establishment of clear guidelines for outpatient liver biopsy in pediatric populations.
Abstract:
Liver biopsy is a valuable tool. Even though outpatient liver biopsies are routinely performed in adults, there are no clear recommendations on its safety and feasibility in children. We reviewed the records of children who underwent a percutaneous liver biopsy at our institution between January 2005 and June 2015. A total of 626 biopsies were performed on 497 patients (250 boys, median age 6 [0.2-19.3] years). Abnormal liver function tests for investigation 288 (46%) was the most common indication. Thirty (4.8%) biopsies had complications, most common being subcapsular hematoma 14 of 30 (46.7%). Complications were identified within 8 hours of the biopsy in all patients. Approach, needle size, or number of passes did not affect the complication rate. Bleeding-related complications were not related to the international normalized ratio. Performing liver biopsies on an outpatient basis would have saved 60 beds/AU$ 80,000/year. The present study suggests that if an observation period of 8 hours is instituted, outpatient liver biopsies can be performed safely in children.
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