Transjugular liver biopsy: a retrospective analysis of 601 cases.

PURPOSE To perform a retrospective analysis of all transjugular liver biopsies (TJLBs) performed during a 77-month period. The authors discuss the technical modifications adopted to achieve better procedural success and histopathologic yield apart from the safety profile of this procedure during the study period. MATERIALS AND METHODS Six hundred one consecutive patients underwent TJLB at the authors' institution during the study period. TJLB was performed when percutaneous biopsy was precluded, being judged unsafe. The left internal jugular vein (IJV) was accessed only when it was not possible to cannulate the right IJV, which was the routine access for this procedure. Biopsy samples were obtained from the right lobe after right hepatic vein cannulation. Left lobe biopsy was done only in select cases. In patients with shrunken liver and unfavorable hepatic veins for cannulation and in those with hepatic veno-occlusive disease, biopsy was performed with a transcaval approach under ultrasonographic (US) guidance, improving our technical success for this procedure over the years. RESULTS The overall technical success rate for the procedure was 98.8 % (594/601), the histopathologic positivity was 97% (576/594), and the overall complication rate was 2.5% (15/601). CONCLUSIONS With technical modifications such as transcaval liver biopsy and with access to US in the angiography suite, interventionalist can achieve higher technical success rates for this procedure. The authors' institutional experience with this procedure reiterates its high histopathologic positivity and safety profile both in adult and pediatric patients.