Transjugular liver biopsy in high-risk patients with hepatic disease.

Records were reviewed of 160 patients who underwent transjugular liver biopsy (TJLB) during a five-year period. Percutaneous transperitoneal needle biopsy was contraindicated in 95% of these patients because of coagulation abnormalities or massive ascites. Moderate complications occurred in two patients. Diagnostic biopsy material was obtained in 129 (81%). TJLB provided useful information in 44 of 58 patients without documented alcohol abuse (clinical Groups III and IV). TJLB disclosed additional diagnoses aside from Laennec cirrhosis in 15 of 48 alcoholic patients with sudden clinical deterioration (Group II), including 11 cases with other stages of alcholic liver disease and four cases of primary or metastatic neoplasm. TJLB revealed diagnoses other than Laennec cirrhosis, including three neoplasms, in six of 54 clinically stable alcoholics (Group I). TJLB frequently yielded important data relative to clinical management or prognosis in Group II, III, and IV patients; it was less useful in Group I patients.

The transjugular route as an alternative to direct percutaneous needle biopsy of the liver.

Transjugular liver biopsy was attempted in 32 cases of hepatocellular dysfunction with hemocoagulation disorders, ascites or marked obesity. A catheter was inserted in the right internal jugular vein and advanced into a hepatic vein under fluoroscopic control. A long needle was passed through the catheter and into the liver parenchyma for the biopsy. Diagnostic specimens were obtained in 28 instances (88%). The procedure was always well tolerated and no complications occurred. The transjugular approach offers a safe, practical alternative for liver biopsy in cases where direct percutaneous puncture is contraindicated.