Transvenous liver biopsy

Interpretation of liver biopsy findings serves as the foundation for the understanding and treatment of liver diseases. Despite rapidly improving molecular, biochemical, and serologic testing, liver biopsy remains the diagnostic gold standard. Histologic assessment provides critical prognostic information and is frequently pivotal in therapeutic decisions. For most individuals, liver biopsy is safely and efficiently performed by the standard percutaneous approach. However, in patients with advanced liver disease, for whom liver biopsy findings may be most critical, bleeding complications after invasive procedure such as a percutaneous liver biopsy can be associated with unacceptable risk. Alternatives for this group have included open or laparoscopic liver biopsy, transjugular liver biopsy (TJLB) or empiric treatment without histology. Of these TJLB provides the least invasive method to obtain reasonable diagnostic material. TJLB has been safely and successfully performed for the past 40 years. Until recently, however, TJLB has been limited by relatively small size of the core liver sample, leading to frequently uninterpretable histologic results. However, greatly improved tissue sampling is now achieved with increased technical experience, incorporation of better radiologic imaging, and improvements in the biopsy needle. In this chapter we review the development of the transjugular liver biopsy, with particular emphasis on the safety and efficacy of this technology, and discuss its role in special patient populations such as children, fulminant hepatitis, and liver transplant recipients.