Cunha-Silva Marlone, Torres Luíza D, Fernandes Mariana F, Secundo Tirzah de M Lopes, Moreira Marina C G, Yamanaka Ademar, Monici Leonardo T, Costa Larissa B Eloy da, Mazo Daniel F, Sevá-Pereira Tiago
Division of Gastroenterology (Gastrocentro), University of Campinas (Unicamp), Campinas, Brazil.
Division of Gastroenterology (Gastrocentro), University of Campinas (Unicamp), Campinas, Brazil.
Gastroenterol Hepatol. 2022 Oct;45(8):579-584. doi: 10.1016/j.gastrohep.2021.12.004. Epub 2021 Dec 17.
Although the use of non-invasive methods for assessment of liver fibrosis has reduced the need for biopsy, the diagnosis of liver damage still requires histological evaluation in many patients. We aim to describe the indications for percutaneous liver biopsy (PLB) and the rate of complications in an outpatient setting over 5 years.
This observational, single-center, and retrospective study included patients submitted to real-time ultrasound (US)-guided biopsies from 2015 to 2019. We collected age, gender, coagulation tests, comorbidities, and the number of needle passes. The association between the variables and complications was evaluated using the generalized estimating equations method.
We analyzed 532 biopsies in 524 patients (55.3% male) with a median age of 49 years (range 13-74y). An average of 130.3 biopsies per year were performed in the first 3 years of the study versus 70.5 in the other 2y. The main indications were hepatitis C virus (HCV) infection (47.0%), autoimmune and cholestatic liver diseases (12.6%), and metabolic dysfunction-associated fatty liver disease (MAFLD) (12.1%). The number of HCV-related biopsies had a remarkable reduction, while MAFLD-related procedures have progressively raised over time. Around 54% of the patients reported pain, which was significantly associated with females (p=0.0143). Serious complications occurred in 11 patients (2.1%) and hospital admission was necessary in 10 cases (1.9%). No patient required surgical approach and there were no deaths. No significant association was found between the studied variables and biopsy-related complications.
The indications for PLB in an outpatient setting have changed from HCV to MAFLD over the years. This procedure is safe and has a low rate of serious complications, but new strategies to prevent the pain are still needed, especially for females.
尽管使用非侵入性方法评估肝纤维化减少了活检的必要性，但在许多患者中，肝损伤的诊断仍需要组织学评估。我们旨在描述经皮肝穿刺活检（PLB）的适应证以及5年门诊环境中的并发症发生率。
这项观察性、单中心回顾性研究纳入了2015年至2019年接受实时超声（US）引导下活检的患者。我们收集了年龄、性别、凝血试验、合并症和穿刺针数。使用广义估计方程法评估变量与并发症之间的关联。
我们分析了524例患者的532次活检（男性占55.3%），中位年龄为49岁（范围13 - 74岁）。研究的前3年平均每年进行130.3次活检，后2年为70.5次。主要适应证为丙型肝炎病毒（HCV）感染（47.0%）、自身免疫性和胆汁淤积性肝病（12.6%）以及代谢功能障碍相关脂肪性肝病（MAFLD）（12.1%）。与HCV相关的活检数量显著减少，而与MAFLD相关的操作随时间逐渐增加。约54%的患者报告有疼痛，这与女性显著相关（p = 0.0143）。11例患者（2.1%）发生严重并发症，10例患者（1.9%）需要住院治疗。无患者需要手术治疗，也无死亡病例。在研究变量与活检相关并发症之间未发现显著关联。
多年来，门诊环境中PLB的适应证已从HCV转变为MAFLD。该操作安全，严重并发症发生率低，但仍需要新的策略来预防疼痛，尤其是对女性而言。
