Anania Giulia, Gigante Elia, Piciucchi Matteo, Pilozzi Emanuela, Pucci Eugenio, Pellicelli Adriano Maria, Capotondi Carlo, Rossi Michele, Baccini Flavia, Antonelli Giulio, Begini Paola, Delle Fave Gianfranco, Marignani Massimo
Giulia Anania, Elia Gigante, Matteo Piciucchi, Flavia Baccini, Giulio Antonelli, Paola Begini, Gianfranco Delle Fave, Massimo Marignani, Department of Digestive and Liver Disease, School of Medicine and Psychology University "Sapienza", 00189 Rome, Italy.
World J Gastrointest Pathophysiol. 2014 May 15;5(2):114-9. doi: 10.4291/wjgp.v5.i2.114.
To analyze the safety and the adequacy of a sample of liver biopsies (LB) obtained by gastroenterologist (G) and interventional radiologist (IR) teams.
Medical records of consecutive patients evaluated at our GI unit from 01/01/2004 to 31/12/2010 for whom LB was considered necessary to diagnose and/or stage liver disease, both in the setting of day hospital and regular admission (RA) care, were retrieved and the data entered in a database. Patients were divided into two groups: one undergoing an ultrasonography (US)-assisted procedure by the G team and one undergoing US-guided biopsy by the IR team. For the first group, an intercostal approach (US-assisted) and a Menghini modified type needle 16 G (length 90 mm) were used. The IR team used a subcostal approach (US-guided) and a semiautomatic modified Menghini type needle 18 G (length 150 mm). All the biopsies were evaluated for appropriateness according to the current guidelines. The number of portal tracts present in each biopsy was assessed by a revision performed by a single pathologist unaware of the previous pathology report. Clinical, laboratory and demographic patient characteristics, the adverse events rate and the diagnostic adequacy of LB were analyzed.
During the study period, 226 patients, 126 males (56%) and 100 females (44%), underwent LB: 167 (74%) were carried out by the G team, whereas 59 (26%) by the IR team. LB was mostly performed in a day hospital setting by the G team, while IR completed more procedures on inpatients (P < 0.0001). The groups did not differ in median age, body mass index (BMI), presence of comorbidities and coagulation parameters. Complications occurred in 26 patients (16 G team vs 10 IR team, P = 0.15). Most gross samples obtained were considered suitable for basal histological evaluation, with no difference among the two teams (96.4% G team vs 91.5% IR, P = 0.16). However, the samples obtained by the G team had a higher mean number of portal tracts (G team 9.5 ± 4.8; range 1-29 vs IR team 7.8 ± 4.1; range 1-20) (P = 0.0192) and a longer mean length (G team 22 mm ± 8.8 vs IR team 15 ± 6.5 mm) (P = 0.0001).
LB can be performed with similar outcomes both by G and IR. Use of larger dimension needles allows obtaining better samples, with a similar rate of adverse events.
分析由胃肠病学家（G）和介入放射科医生（IR）团队获取的肝活检（LB）样本的安全性和充分性。
检索2004年1月1日至2010年12月31日期间在我们胃肠病科接受评估的连续患者的病历，这些患者在日间医院和常规住院（RA）护理环境下，被认为有必要进行LB以诊断和/或分期肝病。数据录入数据库。患者分为两组：一组由G团队进行超声（US）辅助操作，另一组由IR团队进行US引导下活检。对于第一组，采用肋间入路（US辅助）和16G（长度90mm）的改良Menghini型针。IR团队采用肋下入路（US引导）和18G（长度150mm）的半自动改良Menghini型针。根据当前指南评估所有活检的适宜性。由一位不了解先前病理报告的单一病理学家进行复查，评估每个活检中门静脉分支的数量。分析患者的临床、实验室和人口统计学特征、不良事件发生率以及LB的诊断充分性。
在研究期间，226例患者接受了LB，其中男性126例（56%），女性100例（44%）：G团队进行了167例（74%），而IR团队进行了59例（26%）。G团队大多在日间医院环境下进行LB，而IR团队在住院患者中完成的操作更多（P<0.0001）。两组在中位年龄、体重指数（BMI）、合并症的存在情况和凝血参数方面无差异。26例患者发生并发症（G团队16例 vs IR团队10例，P = 0.15）。获得的大多数大体样本被认为适合基础组织学评估，两组之间无差异（G团队96.4% vs IR团队91.5%，P = 0.16）。然而，G团队获得的样本门静脉分支平均数量更高（G团队9.5±4.8；范围1 - 29 vs IR团队7.8±4.1；范围1 - 20）（P = 0.0192），平均长度更长（G团队22mm±8.8 vs IR团队15±6.5mm）（P = 0.0001）。
G团队和IR团队进行LB的结果相似。使用更大尺寸的针可以获得更好的样本，不良事件发生率相似。
