Although gastroenterologists are most commonly trained to perform percutaneous liver biopsies in children, interventional radiologists can perform this procedure equally as safe, according to a study from Nationwide Children’s Hospital. The study, which appears in the Journal of Pediatric Gastroenterology and Nutrition, is the first to report on these biopsies in U.S. children up to 21 years old.
“Liver biopsy is an important diagnostic tool in pediatrics,” said Carol J. Potter, MD, gastroenterologist at Nationwide Children’s and study author. “Yet, a recent Web-based survey of pediatric gastroenterologists found that more than one-third had not performed a percutaneous liver biopsy in the last month.” The majority of these pediatric gastroenterologists referred their patients to an interventional radiology department to perform the biopsy.
“The Accreditation Council for Graduate Medical Education no longer requires technical expertise in actually performing the procedure for pediatric gastroenterology,” said Dr. Potter.
However, documentation of the safety in children of percutaneous liver biopsy performed in the setting of an interventional radiology suite is limited to two reports, one from Rome, Italy and the other describing biopsies in infants younger than 1 year old. “Neither of these clinical scenarios is fully applicable to the emerging practice in children up to 21 years in the United States, where procedural sedation is most often used,” said Dr. Potter.
To assess the safety and effectiveness of percutaneous liver biopsy performed by interventional radiologists in a large, tertiary care children’s hospital, Nationwide Children’s faculty members conducted a retrospective medical record review of 294 percutaneous liver biopsies performed during an 11 year period at their hospital.
Patients ranged from 8 days of age to 20 years with a mean age of 10.2 years. During the analyzed years, no percutaneous biopsies were performed by pediatric gastroenterologists. Complications, mortality, transfusion rate and success rate were comparable to data reported in existing studies involving gastroenterologists.
“Our findings indicate that liver biopsy performed by an interventional radiologist is as least as safe and effective as that reported by gastroenterologists,” said Dr. Potter.
Potter C, Hogan MJ, Henry-Kendjorsky K, Balint J, Barnard JA. Safety of pediatric percutaneous liver biopsy performed by interventional radiologists. J Pediatr Gastroenterol Nutr. 2011 Aug;53(2):202-6.