Transjugular liver biopsy in the 1990s: a 2-year audit

Background In view of the changing nature of transjugular liver biopsy, we performed an audit of the safety, adequacy and clinical impact of such biop sies in our centre over a 2-year period from 1995 to 1997. Methods: One hundred and fifty-seven transjugular biopsies were carried out in 145 patients, with prothrombin time >5 s over control and/or platelet c ount <50 x 10(9)/L and/or gross ascites. Results: Major complications were two (1.3%) capsular perforations, which w ere easily plugged with coils without sequelae, Biopsy sample was adequate for histological diagnosis in 90%, inadequate in 6% and technically unsucce ssful in 4% of cases, Mean biopsy size was 14.8 +/- 7.7 (1-51) mm. Adequacy did not differ between cases with and without cirrhosis. Transjugular biop sy had a clinical impact (specific diagnosis or influence on patient's mana gement) in 50% of acute liver disease, 62% of chronic liver disease and 87% of transplant patients (P < 0.001). In chronic liver disease, it had a sig nificantly greater clinical impact in cases trying to establish the stage r ather than diagnosis (84% vs. 35%, P < 0.001). Conclusions: Transjugular liver biopsy is a safe procedure for high-risk pa tients providing an adequate liver sample even in cirrhosis, It has a clini cal impact in more than 80% of transplant patients and for staging chronic liver disease, but in only 50% (acute) or 35% (chronic) of liver disease wh en a diagnosis is sought.