Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2023; 15(7): 1388-1396
Published online Jul 27, 2023. doi: 10.4240/wjgs.v15.i7.1388
Major complications after ultrasound-guided liver biopsy: An annual audit of a Chinese tertiary-care teaching hospital
Wei-Lu Chai, Dan-Lei Lu, Zhong-Xia Sun, Chao Cheng, Zhuang Deng, Xin-Yan Jin, Tong-Long Zhang, Qiong Gao, Yu-Wei Pan, Qi-Yu Zhao, Tian-An Jiang
Wei-Lu Chai, Dan-Lei Lu, Zhong-Xia Sun, Xin-Yan Jin, Tong-Long Zhang, Qiong Gao, Yu-Wei Pan, Qi-Yu Zhao, Tian-An Jiang, Department of Ultrasonography, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Chao Cheng, Zhuang Deng, Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Author contributions: Jiang TA and Chai WL contributed to conceptualization; Chai WL, Lu DL and Jiang TA contributed to data curation; Chai WL and Sun ZX contributed to formal analysis; Jiang TA contributed to funding acquisition and resources; Chai WL, Cheng C, Jin XY, Deng Z, Zhang TL, Zhao QY and Jiang TA contributed to investigation; Chai WL and Gao Q contributed to methodology; Jiang TA, Sun ZX, Zhao QY, Lu DL and Pan YW contributed to project administration; Chai WL and Lu DL contributed software; Zhao QY, Jiang TA and Sun ZX contributed to supervision; Chai WL and Jiang TA contributed to validation; Chai WL contributed to writing the original draft; Zhao QY and Jiang TA contributed to reviewing and editing.
Institutional review board statement: Ethical approval was obtained from the Clinical Research Ethics Committee of the First Affiliated Hospital, Zhejiang University School of Medicine before the study.
Informed consent statement: The requirement for informed consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tian-An Jiang, PhD, Chief Doctor, Researcher, Teacher, Department of Ultrasonography, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. tiananjiang@zju.edu.cn
Received: February 11, 2023
Peer-review started: February 11, 2023
First decision: March 26, 2023
Revised: April 5, 2023
Accepted: May 6, 2023
Article in press: May 6, 2023
Published online: July 27, 2023
ARTICLE HIGHLIGHTS
Research background

As ultrasound-guided percutaneous liver biopsy (PLB) has become a standard and important method in the management of liver disease in our country, a periodical audit of the major complications is needed.

Research motivation

As ultrasound-guided PLB has become a standard and important method in the management of liver disease in our country, a periodical audit on its application and complications is needed to ensure that the complication rate is within the accepted range and to further optimize the procedure. Therefore, we carried out this study to determine the annual incidence of major complications following ultrasound-guided PLB in a Chinese tertiary-care teaching hospital and to identify significant variables associated with an increased risk of major complications.

Research objectives

The aim of this study was to determine the annual incidence of major complications following ultrasound-guided PLB and to identify variables that were significantly associated with an increased risk of major complications.

Research methods

A total of 1857 consecutive cases of PLB were included in our hospital from January 2021 to December 2021. The major complication rate and all-cause 30-d mortality rate were determined. Multivariate analyses were performed by logistic regression to investigate the risk factors associated with major complications and all-cause 30-d mortality following ultrasound-guided PLB.

Research results

In this audit of 1857 liver biopsies, 10 cases (0.53%) of major complications occurred following ultrasound-guided PLB. The overall all-cause mortality rate at 30 d after PLB was 0.27% (5 cases), and 2 cases (0.11%) were attributed to major hemorrhage within 7 d after liver biopsy. Fibrinogen less than 2 g/L [odds ratio (OR): 17.226; 95% confidence interval (CI): 2.647-112.102; P = 0.003], post-biopsy hemoglobin level (OR: 0.963; 95%CI: 0.942-0.985; P = 0.001), obstructive jaundice (OR: 6.698; 95%CI: 1.133-39.596; P = 0.036), application of anticoagulants/antiplatelet medications (OR: 24.078; 95%CI: 1.678-345.495; P = 0.019) and age (OR: 1.096; 95%CI: 1.012-1.187; P = 0.025) were statistically associated with the incidence of major complications after PLB.

Research conclusions

In conclusion, the results of this annual audit confirmed that ultrasound-guided PLB can be performed safely, with a major complication rate within the accepted range. Strict patient selection and peri-biopsy laboratory assessment are more important than procedural factors for optimizing the safety outcomes of this procedure.

Research perspectives

A large-scale, multicenter and prospective study is warranted to validate the findings of our study, especially the administration of peri-biopsy coagulants/antiplatelet medications and the assessment of the baseline coagulation profile.