Öz
Aim: Liver biopsy is a procedure carried out to
diagnose and grade the liver disease, to estimate the prognosis and to give the
decision of treatment. Despite the developing imaging techniques, serological
findings used in diagnosis of liver disease and all the other laboratory
facilities, the requirement for liver biopsy has not declined, on the contrary
it has increased, appearing in a different characteristic. İn this study, we
investigated the indications and complications of the liver biopsy, the factors
upon which the complications depend, the adequacy of biopsies performed, the
cost of biopsies, whether all these factors create a discrepancy between the
groups.
Material
and Method: İn this
retrospective study, the files of 553 patients, 213 (38,5%) of whom were outpatients
and 340 (61,5%) of whom were inpatients, were screened. When the results of the
complete blood count, routine biochemistry, INR and PT carried out before the
biopsy were assessed, there was no significant difference between two groups
except for the results of albumin, creatinin and alkaline phosphatase.
Results:
Albumin was high in the outpatient group,
whereas creatinin was high in the inpatient group. Menghini needle was used in
98 % of 213 outpatients and tru-cut needle was used in 1,9% of 213 outpatiens,
While tru-cut needle was used in 99,1% of 340 inpatients, Menghini needle was
used in 0,9% of 340 inpatients. Minor complications were observed in 18,3% of
outpatients and 40,2% of inpatients (p<0,05). Although no majör
complications were observed in the outpatients, they were observed in the 6
(1,7%) inpatients (p<0,05). Complications were associated with the
experience of the physician, the number of passes, the use of tru-cut needle,
the prolongation of PT value, trombocyte count below 80000/mm3, the INR value
over 1,2. The average cost of outpatient biopsy was 137±22 YTL, while it was
214±11 YTL inpatient (p<0,05).
Conclusion: Consequently, the outpatient liver biopsies
performed by the experienced staff are both safer and less expensive than the
inpatient liver biopsies. Post liver biopsy complications are associated with
the experience of physician, the method, the number of passes, disorders of
hemostasis.
Anahtar Kelimeler
Outpatient and inpatient liver biopsy biopsy complications risk factors
Kaynakça
- 1. Bravo, A.A., S.G. Sheth, and S. Chopra, Liver biopsy. N Engl J Med, 2001. 344(7): p. 495-500.
- 2. Tapper, E.B. and A.S.F. Lok, Use of Liver Imaging and Biopsy in Clinical Practice. N Engl J Med, 2017. 377(23): p. 2296-2297.
- 3. Campbell, M.S. and K.R. Reddy, Review article: the evolving role of liver biopsy. Aliment Pharmacol Ther, 2004. 20(3): p. 249-59.
- 4. Garcia-Tsao, G. and J.L. Boyer, Outpatient liver biopsy: how safe is it? Ann Intern Med, 1993. 118(2): p. 150-3.
- 5. van der Poorten, D., et al., Twenty-year audit of percutaneous liver biopsy in a major Australian teaching hospital. Intern Med J, 2006. 36(11): p. 692-9.
- 6. Rockey, D.C., et al., Liver biopsy. Hepatology, 2009. 49(3): p. 1017-44.
- 7. Gilmore, I.T., et al., Indications, methods, and outcomes of percutaneous liver biopsy in England and Wales: an audit by the British Society of Gastroenterology and the Royal College of Physicians of London. Gut, 1995. 36(3): p. 437-41.
- 8. Perrault, J., et al., Liver biopsy: complications in 1000 inpatients and outpatients. Gastroenterology, 1978. 74(1): p. 103-6.
- 9. Sheela, H., et al., Liver biopsy: evolving role in the new millennium. J Clin Gastroenterol, 2005. 39(7): p. 603-10.
- 10. Grant, A. and J. Neuberger, Guidelines on the use of liver biopsy in clinical practice. British Society of Gastroenterology. Gut, 1999. 45 Suppl 4: p. IV1-IV11.
- 11. Montalto, G., et al., Percutaneous liver biopsy: a safe outpatient procedure? Digestion, 2001. 63(1): p. 55-60.
- 12. Spiezia, S., et al., The efficacy of liver biopsy under ultrasonographic guidance on an outpatient basis. Eur J Ultrasound, 2002. 15(3): p. 127-31.
- 13. Douds, A.C. and J.D. Maxwell, Liver biopsy. Day case procedure is safe. BMJ, 1995. 310(6981): p. 739.
- 14. Hegarty, J.E. and R. Williams, Liver biopsy: techniques, clinical applications, and complications. Br Med J (Clin Res Ed), 1984. 288(6426): p. 1254-6.
- 15. McGill, D.B., et al., A 21-year experience with major hemorrhage after percutaneous liver biopsy. Gastroenterology, 1990. 99(5): p. 1396-400.
- 16. Bedossa, P., D. Dargere, and V. Paradis, Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology, 2003. 38(6): p. 1449-57.
- 17. Piccinino, F., et al., Complications following percutaneous liver biopsy. A multicentre retrospective study on 68,276 biopsies. J Hepatol, 1986. 2(2): p. 165-73.
- 18. de Man, R.A., H.R. van Buuren, and W.C. Hop, A randomised study on the efficacy and safety of an automated Tru-Cut needle for percutaneous liver biopsy. Neth J Med, 2004. 62(11): p. 441-5.
- 19. Sugano, S., et al., Incidence of ultrasound-detected intrahepatic hematomas due to Tru-cut needle liver biopsy. Dig Dis Sci, 1991. 36(9): p. 1229-33.
- 20. McVay, P.A. and P.T. Toy, Lack of increased bleeding after liver biopsy in patients with mild hemostatic abnormalities. Am J Clin Pathol, 1990. 94(6): p. 747-53.
- 21. Rebulla, P., Platelet transfusion trigger in difficult patients. Transfus Clin Biol, 2001. 8(3): p. 249-54.
- 22. Dillon, J.F., K.J. Simpson, and P.C. Hayes, Liver biopsy bleeding time: an unpredictable event. J Gastroenterol Hepatol, 1994. 9(3): p. 269-71.
- 23. Papatheodoridis, G.V., et al., Transjugular liver biopsy in the 1990s: a 2-year audit. Aliment Pharmacol Ther, 1999. 13(5): p. 603-8.
- 24. Sparchez, Z., Complications after percutaneous liver biopsy in diffuse hepatopathies. Rom J Gastroenterol, 2005. 14(4): p. 379-84.
- 25. Tan, K.T., et al., Pain after percutaneous liver biopsy for diffuse hepatic disease: a randomized trial comparing subcostal and intercostal approaches. J Vasc Interv Radiol, 2005. 16(9): p. 1215-9.
- 26. Eisenberg, E., et al., Prevalence and characteristics of pain induced by percutaneous liver biopsy. Anesth Analg, 2003. 96(5): p. 1392-6, table of contents.
- 27. Actis, G.C., et al., The practice of percutaneous liver biopsy in a gastrohepatology day hospital: a retrospective study on 835 biopsies. Dig Dis Sci, 2007. 52(10): p. 2576-9.
- 28. Riley, T.R., 3rd, Predictors of pain medication use after percutaneous liver biopsy. Dig Dis Sci, 2002. 47(10): p. 2151-3.
- 29. Sheets, P.W., et al., Safety and efficacy of a spring-propelled 18-gauge needle for US-guided liver biopsy. J Vasc Interv Radiol, 1991. 2(1): p. 147-9.
- 30. Lindor, K.D., et al., The role of ultrasonography and automatic-needle biopsy in outpatient percutaneous liver biopsy. Hepatology, 1996. 23(5): p. 1079-83.
- 31. Cadranel, J.F., P. Rufat, and F. Degos, Practices of liver biopsy in France: results of a prospective nationwide survey. For the Group of Epidemiology of the French Association for the Study of the Liver (AFEF). Hepatology, 2000. 32(3): p. 477-81.
- 32. Van Thiel, D.H., et al., Liver biopsy. Its safety and complications as seen at a liver transplant center. Transplantation, 1993. 55(5): p. 1087-90.
- 33. Sorbi, D., et al., An assessment of the role of liver biopsies in asymptomatic patients with chronic liver test abnormalities. Am J Gastroenterol, 2000. 95(11): p. 3206-10.
- 34. Castera, L., et al., Pain experienced during percutaneous liver biopsy. Hepatology, 1999. 30(6): p. 1529-30.
- 35. Terjung, B., et al., Bleeding complications after percutaneous liver biopsy. An analysis of risk factors. Digestion, 2003. 67(3): p. 138-45.
- 36. Smirniotopoulos, J., P. Barone, and M. Schiffman, Unexplained gastrointestinal bleed due to arteriobiliary fistula after percutaneous liver biopsy. Clin Imaging, 2017. 42: p. 106-108.
- 37. Van Os, E.C. and B.T. Petersen, Pancreatitis secondary to percutaneous liver biopsy-associated hemobilia. Am J Gastroenterol, 1996. 91(3): p. 577-80.
- 38. Machicao, V.I., et al., Arterioportal fistula causing acute pancreatitis and hemobilia after liver biopsy. J Clin Gastroenterol, 2002. 34(4): p. 481-4.
- 39. Rivera-Sanfeliz, G., et al., Single-pass percutaneous liver biopsy for diffuse liver disease using an automated device: experience in 154 procedures. Cardiovasc Intervent Radiol, 2005. 28(5): p. 584-8.
- 40. Smith, B.C. and P.V. Desmond, Outpatient liver biopsy using ultrasound guidance and the Biopty gun is safe and cost effective. Aust N Z J Med, 1995. 25(3): p. 209-11.
Diffüz karaciğer hastalıkları nedeniyle ayaktan veya yatarak yapılan karaciğer biyopsilerinin analizi
Öz
Giriş: Karaciğer
biyopsisi karaciğer hastalıklarının tanısı, evrelendirilmesi, prognozun tahmini
ve hastaların tedavi kararlarının verilmesi için yapılan bir işlemdir.
Günümüzde gelişen görüntüleme yöntemleri, karaciğer hastalığının tanısında
yararlandığımız serolojik göstergeler ve diğer bütün laboratuvar olanaklarına
rağmen karaciğer biyopsisine duyulan gereksinim azalmamış, tersine nitelik
değiştirmesine rağmen artmıştır.
Gereç
ve Yöntem: Bu çalışmada hastanemizde Ocak 1998 ve Haziran
2007 tarihleri arasında, ayaktan ve yatarak yapılan karaciğer biyopsilerinin
endikasyonları, komplikasyonları, biyopsilerin maliyetleri retrospektif olarak değerlendirildi.
Bulgular:
Ayaktan biyopsi yapılan 213 (%38,5) hasta ile
yatarak biyopsi yapılan 340 (%61,5) hasta değerlendirilmeye alındı. Ayaktan
biyopsi yapılan hastalarda majör komplikasyon görülmezken; yatarak biyopsi
yapılan hasta grubunda 6 (%1,7) hastada tespit edildi (p<0,05).
Komplikasyonların bağlı olduğu faktörler hekimin tecrübesi, işlem sayısı, tru-cut
iğne kullanımı, PT değerinde 4 sn ve üzerindeki uzamalar, trombosit değerinin
80000/mm3 ve altında olması, INR değerinin 1,2 ve üzerinde
olmasıdır. Her iki grup içinde 192 hastanın maliyet kayıtlarına ulaşılabildi.
Ayaktan biyopsi yapılan grubun ortalama maliyeti 137±22YTL, yatarak biyopsi
yapılan grubun 214±11YTL idi (p<0,05).
Sonuç:
Tecrübeli ellerde ayaktan yapılan karaciğer biyopsileri, en az yatarak
yapılan karaciğer biyopsileri kadar güvenli ve maliyeti de daha düşüktür.
Karaciğer biyopsisi sonrası komplikasyonlar hekimin tecrübesi, yöntem, işlem
sayısı, hemostaz bozuklukları ile bağlantılı bulunmuştur.
Anahtar Kelimeler
Ayaktan ve yatarak karaciğer biyopsisi biyopsi komplikasyonları risk faktörleri
Kaynakça
- 1. Bravo, A.A., S.G. Sheth, and S. Chopra, Liver biopsy. N Engl J Med, 2001. 344(7): p. 495-500.
- 2. Tapper, E.B. and A.S.F. Lok, Use of Liver Imaging and Biopsy in Clinical Practice. N Engl J Med, 2017. 377(23): p. 2296-2297.
- 3. Campbell, M.S. and K.R. Reddy, Review article: the evolving role of liver biopsy. Aliment Pharmacol Ther, 2004. 20(3): p. 249-59.
- 4. Garcia-Tsao, G. and J.L. Boyer, Outpatient liver biopsy: how safe is it? Ann Intern Med, 1993. 118(2): p. 150-3.
- 5. van der Poorten, D., et al., Twenty-year audit of percutaneous liver biopsy in a major Australian teaching hospital. Intern Med J, 2006. 36(11): p. 692-9.
- 6. Rockey, D.C., et al., Liver biopsy. Hepatology, 2009. 49(3): p. 1017-44.
- 7. Gilmore, I.T., et al., Indications, methods, and outcomes of percutaneous liver biopsy in England and Wales: an audit by the British Society of Gastroenterology and the Royal College of Physicians of London. Gut, 1995. 36(3): p. 437-41.
- 8. Perrault, J., et al., Liver biopsy: complications in 1000 inpatients and outpatients. Gastroenterology, 1978. 74(1): p. 103-6.
- 9. Sheela, H., et al., Liver biopsy: evolving role in the new millennium. J Clin Gastroenterol, 2005. 39(7): p. 603-10.
- 10. Grant, A. and J. Neuberger, Guidelines on the use of liver biopsy in clinical practice. British Society of Gastroenterology. Gut, 1999. 45 Suppl 4: p. IV1-IV11.
- 11. Montalto, G., et al., Percutaneous liver biopsy: a safe outpatient procedure? Digestion, 2001. 63(1): p. 55-60.
- 12. Spiezia, S., et al., The efficacy of liver biopsy under ultrasonographic guidance on an outpatient basis. Eur J Ultrasound, 2002. 15(3): p. 127-31.
- 13. Douds, A.C. and J.D. Maxwell, Liver biopsy. Day case procedure is safe. BMJ, 1995. 310(6981): p. 739.
- 14. Hegarty, J.E. and R. Williams, Liver biopsy: techniques, clinical applications, and complications. Br Med J (Clin Res Ed), 1984. 288(6426): p. 1254-6.
- 15. McGill, D.B., et al., A 21-year experience with major hemorrhage after percutaneous liver biopsy. Gastroenterology, 1990. 99(5): p. 1396-400.
- 16. Bedossa, P., D. Dargere, and V. Paradis, Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology, 2003. 38(6): p. 1449-57.
- 17. Piccinino, F., et al., Complications following percutaneous liver biopsy. A multicentre retrospective study on 68,276 biopsies. J Hepatol, 1986. 2(2): p. 165-73.
- 18. de Man, R.A., H.R. van Buuren, and W.C. Hop, A randomised study on the efficacy and safety of an automated Tru-Cut needle for percutaneous liver biopsy. Neth J Med, 2004. 62(11): p. 441-5.
- 19. Sugano, S., et al., Incidence of ultrasound-detected intrahepatic hematomas due to Tru-cut needle liver biopsy. Dig Dis Sci, 1991. 36(9): p. 1229-33.
- 20. McVay, P.A. and P.T. Toy, Lack of increased bleeding after liver biopsy in patients with mild hemostatic abnormalities. Am J Clin Pathol, 1990. 94(6): p. 747-53.
- 21. Rebulla, P., Platelet transfusion trigger in difficult patients. Transfus Clin Biol, 2001. 8(3): p. 249-54.
- 22. Dillon, J.F., K.J. Simpson, and P.C. Hayes, Liver biopsy bleeding time: an unpredictable event. J Gastroenterol Hepatol, 1994. 9(3): p. 269-71.
- 23. Papatheodoridis, G.V., et al., Transjugular liver biopsy in the 1990s: a 2-year audit. Aliment Pharmacol Ther, 1999. 13(5): p. 603-8.
- 24. Sparchez, Z., Complications after percutaneous liver biopsy in diffuse hepatopathies. Rom J Gastroenterol, 2005. 14(4): p. 379-84.
- 25. Tan, K.T., et al., Pain after percutaneous liver biopsy for diffuse hepatic disease: a randomized trial comparing subcostal and intercostal approaches. J Vasc Interv Radiol, 2005. 16(9): p. 1215-9.
- 26. Eisenberg, E., et al., Prevalence and characteristics of pain induced by percutaneous liver biopsy. Anesth Analg, 2003. 96(5): p. 1392-6, table of contents.
- 27. Actis, G.C., et al., The practice of percutaneous liver biopsy in a gastrohepatology day hospital: a retrospective study on 835 biopsies. Dig Dis Sci, 2007. 52(10): p. 2576-9.
- 28. Riley, T.R., 3rd, Predictors of pain medication use after percutaneous liver biopsy. Dig Dis Sci, 2002. 47(10): p. 2151-3.
- 29. Sheets, P.W., et al., Safety and efficacy of a spring-propelled 18-gauge needle for US-guided liver biopsy. J Vasc Interv Radiol, 1991. 2(1): p. 147-9.
- 30. Lindor, K.D., et al., The role of ultrasonography and automatic-needle biopsy in outpatient percutaneous liver biopsy. Hepatology, 1996. 23(5): p. 1079-83.
- 31. Cadranel, J.F., P. Rufat, and F. Degos, Practices of liver biopsy in France: results of a prospective nationwide survey. For the Group of Epidemiology of the French Association for the Study of the Liver (AFEF). Hepatology, 2000. 32(3): p. 477-81.
- 32. Van Thiel, D.H., et al., Liver biopsy. Its safety and complications as seen at a liver transplant center. Transplantation, 1993. 55(5): p. 1087-90.
- 33. Sorbi, D., et al., An assessment of the role of liver biopsies in asymptomatic patients with chronic liver test abnormalities. Am J Gastroenterol, 2000. 95(11): p. 3206-10.
- 34. Castera, L., et al., Pain experienced during percutaneous liver biopsy. Hepatology, 1999. 30(6): p. 1529-30.
- 35. Terjung, B., et al., Bleeding complications after percutaneous liver biopsy. An analysis of risk factors. Digestion, 2003. 67(3): p. 138-45.
- 36. Smirniotopoulos, J., P. Barone, and M. Schiffman, Unexplained gastrointestinal bleed due to arteriobiliary fistula after percutaneous liver biopsy. Clin Imaging, 2017. 42: p. 106-108.
- 37. Van Os, E.C. and B.T. Petersen, Pancreatitis secondary to percutaneous liver biopsy-associated hemobilia. Am J Gastroenterol, 1996. 91(3): p. 577-80.
- 38. Machicao, V.I., et al., Arterioportal fistula causing acute pancreatitis and hemobilia after liver biopsy. J Clin Gastroenterol, 2002. 34(4): p. 481-4.
- 39. Rivera-Sanfeliz, G., et al., Single-pass percutaneous liver biopsy for diffuse liver disease using an automated device: experience in 154 procedures. Cardiovasc Intervent Radiol, 2005. 28(5): p. 584-8.
- 40. Smith, B.C. and P.V. Desmond, Outpatient liver biopsy using ultrasound guidance and the Biopty gun is safe and cost effective. Aust N Z J Med, 1995. 25(3): p. 209-11.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Eylül 2018 |
| Yayımlandığı Sayı | Yıl 2018 Cilt: 10 Sayı: 3 |
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