Performance and complications rate of liver biopsies performed by trainees in a newly established Hepatology Department

Aim:

to investigate the performance and complications rate of liver biopsies performed by trainees.

Methods:

Our retrospective study included liver biopsies (for diffuse liver disease and liver tumors) performed by trainees between 01/2016 – 02/2019 in our newly established Hepatology-Department in a University affiliated tertiary care teaching hospital.

Biopsies for liver tumors where performed with ultrasound guidance with a Tru-Cut 16G needle (TrueCore II, Argon Medical Devices), while the biopsies for diffuse liver disease where performed with a Menghini 16 G (Braun Hepafix 16G) or TruCut 16G needle.

Results:

142/180 (78.8%) of the liver biopsies performed during the study period where done by 8 trainees and included into the final analysis. The mean age of patients was 62.2 ± 14.2 years (61.2% male).

Biopsies for diffuse liver disease where performed in 58 cases (40.8%), while in 84 cases (59.2%) ultrasound guided biopsies to diagnose liver tumors where done.

Mild pain after biopsies where documented in 19 cases (13.3%), while severe bleeding requiring blood transfusions occurred in 2 cases (1.4%; one liver bleeding and one hemothorax).

Malignant etiology was present in 94% of patients with liver tumors. The main etiologies were: hepatocellular carcinoma (36.7%), cholangiocellular carcinoma (21.5%) and metastasis from pancreatic cancer (18.9%).

Histology was positive in 65/79 (82.2%) cases with malignant liver tumors. In 4 cases with a first negative biopsy, a second biopsy performed by another trainee was positive in 3/4 (75%) cases.

The main 3 indication for diffuse liver biopsy were: autoimmune liver diseases (40.6%), non-alcoholic steatohepatitis (25.4%) and drug induced liver injury (10.1%). Menghini 16G needle was used in 72.5% of cases for diffuse liver disease.

The mean length of liver biopsy specimen was 2.3 ± 0.8 cm, significantly longer for Menghini as compared with TruCut needle: 2.5 ± 0.8 cm vs. 1.7 ± 0.6 cm, p = 0.001.

Conclusion:

We observed a good performance of liver biopsies performed by trainees with a low complications rate.