Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India.
Department of Gastroenterology, PACE Hospital, Hyderabad, India.
Acta Radiol. 2023 May;64(5):1775-1782. doi: 10.1177/02841851231151513. Epub 2023 Jan 24.
Percutaneous liver biopsy is the gold standard test for the assessment of liver disease. In patients with coagulopathy, ascites, post-transplantation, and hypervascular tumors, biopsy is associated with increased risk of adverse events (AEs). Transjugular liver biopsy (TJLB) is recommended in these conditions but is expensive and unavailable at many centers. Plugged liver biopsy (PLB) provides an alternate diagnostic modality in these high-risk cases.
To analyze the pooled diagnostic outcome and safety of PLB in high-risk cases.
A literature search of various databases from January 1990 to July 2022 was conducted for studies evaluating the outcome of PLB in high-risk cases. The primary outcomes were pooled sample adequacy and AEs. Pooled event rates across studies were expressed with summative statistics.
A total of 17 studies (2329 patients) were included in the meta-analysis. The pooled proportion of sample adequacy was 98.9% (95% confidence interval [CI]=98.2-99.6). Severe AEs, major bleeding, and minor AEs were seen in 0.7% (95% CI=0.1-1.3), 0.4% (95% CI=0.1-0.8), and 11.5% (95% CI=2.4-20.6) of the patients. There was only one reported mortality, giving a pooled incidence of 0.0002% (95% CI=0.0-0.0038). Compared to TJLB (5 studies, n = 336), there was no difference in either sample adequacy (odds ratio [OR]=2.34, 95% CI=0.83-6.58) or risk of serious AEs (OR=0.47, 95% CI=0.173-1.31).
PLB can be safely performed on patients with coagulopathy and/or ascites with high sample adequacy rates and low incidence of AEs and mortality.
经皮肝脏活检是评估肝脏疾病的金标准检测方法。在存在凝血功能障碍、腹水、移植后和富血管性肿瘤的患者中，活检与不良事件（AE）风险增加相关。在这些情况下，推荐行经颈静脉肝脏活检（TJLB），但这种方法费用高，且许多中心无法开展。在这些高危情况下，使用经皮肝穿刺活检（PLB）提供了另一种诊断方法。
分析高危情况下 PLB 的汇总诊断结果和安全性。
对 1990 年 1 月至 2022 年 7 月期间各数据库的文献进行了检索，以评估 PLB 在高危情况下的研究结果。主要结果是汇总样本充足性和 AE。通过总结性统计数据来表达研究间的汇总事件发生率。
共纳入 17 项研究（2329 例患者）进行荟萃分析。汇总的样本充足率为 98.9%（95%置信区间[CI]：98.2-99.6）。严重 AE、大出血和轻微 AE 在 0.7%（95%CI：0.1-1.3）、0.4%（95%CI：0.1-0.8）和 11.5%（95%CI：2.4-20.6）的患者中出现。仅有 1 例报告死亡，汇总发生率为 0.0002%（95%CI：0.0-0.0038）。与 TJLB（5 项研究，n=336）相比，样本充足率（优势比[OR]=2.34，95%CI：0.83-6.58）或严重 AE 风险（OR=0.47，95%CI：0.173-1.31）均无差异。
PLB 可安全用于存在凝血功能障碍和/或腹水的患者，其样本充足率高，AE 和死亡率低。
