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BackgroundApproaches to liver biopsy have changed over the past decade in patients with chronic liver disease.AimsWe conducted a systematic review and meta-analysis on the incidence of all complications and technical failure associated with percutaneous liver biopsy.MethodsWe systematically searched PubMed and the Cochrane Library for cohort studies reporting on complications resulting from liver biopsy published between 2010 and 2020. Studies on participants of any age and sex, who underwent any percutaneous biopsy for non-focal liver disease, were selected. All events except mild pain, minor hematoma, vasovagal episodes, fever and fistula were defined as major complications. Random-effect model meta-analyses with and without covariates were performed, to examine the effect of publication year, patient characteristics, outcome collection, and biopsy type on incidences.ResultsWe identified 30 studies reporting on complications resulting from percutaneous liver biopsy procedures (n = 64,356). Incidence of major complications was 2.44% (95% CI 0.85, 6.75), with mortality at 0.01% (95% CI 0.00, 0.11), hospitalization at 0.65% (95% CI 0.38, 1.11), major bleeding at 0.48% (95% CI 0.22, 1.06), and moderate/severe pain at 0.34% (95% CI 0.08, 1.37). Minor complications at 9.53% (95% CI 3.68, 22.5) were mainly pain at 12.9% (95% CI 5.34, 27.9). Technical failure was high at 0.91% (95% CI 0.27, 3.00). Decreasing patient age significantly increased incidence of hospitalization and major bleeding (P < 0.0001). Hospitalization incidence also significantly increased with disease severity.ConclusionsIncidence of major (2.4%) and minor (9.5%) complications, and technical failure (0.91%) in percutaneous liver biopsies continues.

There is scarce and conflicting evidence on the comparison between endoscopic ultrasound (EUS) and percutaneous (PC)-guided liver biopsy (LB). The aim of this study was to compare the two approaches in a series of patients with parenchymal and focal liver lesions. Fifty-four patients undergoing EUS-LB in two high-volume centers between 2017 and 2021 were compared to 62 patients who underwent PC-LB. The primary outcome was diagnostic adequacy rate. The secondary outcomes were diagnostic accuracy, total sample length (TSL), number of complete portal tracts (CPTs), procedural duration, and adverse events. Variables were compared using the Chi-square and Mann–Whitney test. Median age was 56 years (interquartile range 48–69) in the EUS-LB group and 54 years (45–67) in the PC-LB group with most patients being male. Indication for LB was due to parenchymal disease in 50% of patients, whereas the other patients underwent LB due to focal liver lesions. Diagnostic adequacy was 100% in PC-LB and 94.4% in the EUS-LB group (p = 0.74), whereas diagnostic accuracy was 88.8% in the EUS-LB group and 100% in the PC-LB group (p = 0.82). Median TSL was significantly greater in the PC-LB group (27.4 mm, IQR 21–29) when compared to the EUS-LB group (18.5 mm, 10.1–22.4; p = 0.02). The number of complete portal tracts was 21 (11–24) in the PC-LB group and 18.5 (10–23.2) in EUS-LB group (p = 0.09). EUS-LB was a significantly longer procedure (7 min, 5–11 versus 1 min, 1–3 of PC-LB; p < 0.001) and no evidence of adverse events was observed in any of the study groups. These results were confirmed in the subgroup analysis performed according to an indication for LB (parenchymal disease versus focal lesion). Although PC-LB yielded specimens with greater TSL, diagnostic adequacy and accuracy were similar between the two procedures.

We aim to present a practical approach to imaging in suspected biliary atresia, an inflammatory cholangiopathy of infancy resulting in progressive fibrosis and obliteration of extrahepatic and intrahepatic bile ducts. Left untreated or with failure of the Kasai procedure, biliary atresia progresses to biliary cirrhosis, end-stage liver failure and death within the first years of life. Differentiating biliary atresia from other nonsurgical causes of neonatal cholestasis is difficult as there is no single method for diagnosing biliary atresia and clinical, laboratory and imaging features of this disease overlap with those of other causes of neonatal cholestasis. In this second part, we discuss the roles of magnetic resonance (MR) cholecystopancreatography, hepatobiliary scintigraphy, percutaneous biopsy and percutaneous cholecysto-cholangiography. Among imaging techniques, ultrasound (US) signs have a high specificity, although a normal US examination does not rule out biliary atresia. Other imaging techniques with direct opacification of the biliary tree combined with percutaneous liver biopsy have roles in equivocal cases. MR cholecystopancreatography and hepatobiliary scintigraphy are not useful for the diagnosis of biliary atresia. We propose a decisional flowchart for biliary atresia diagnosis based on US signs, including elastography, percutaneous cholecysto-cholangiography or endoscopic retrograde cholangiopancreatography and liver biopsy.

Background Liver biopsy is a procedure whereby a biopsy needle is used to extract tissue from the liver parenchyma or focal lesions of the liver for pathological or microbiological examination. Percutaneous liver biopsy(PC-LB) is the most commonly employed and least expensive modality. However, it is associated with a significant risk of bleeding complications, which may potentially result in patient mortality. The objective of this study was to investigate the efficacy of Absorbable Gelatin Sponge sheet filler agent (AGS-SFA) in preventing bleeding complications during liver tissue biopsy and to validate a cost-effective surgical technique. Methods In this study, patients who underwent ultrasound-guided percutaneous liver tissue biopsy at our hospital were selected and randomly assigned to either an observation or control group. The observation group employed the use of AGS-SFA to fill the biopsy needle channel. Immediately following the biopsy procedure, the biopsy needle path was examined using Doppler ultrasound. The incidence of bleeding complications following biopsy and the associated factors influencing bleeding were analysed in the two groups. Results The observation and control groups were successfully biopsied, with a 100% success rate for both. The incidence of bleeding complications was significantly lower in the observation group than in the control group. Four factors, including fatty liver, prothrombin time, albumin and INR, were found to have a significant effect on biopsy bleeding in the control group. Conclusion The use of coaxial needles to inject AGS-SFA is an effective and economical procedure that significantly improves the safety of biopsy without increasing the burden of patient care.

Objective To evaluate the current status and factors influencing the occurrence of percutaneous liver biopsy bleeding in children through a retrospective study, and to develop and validate a risk prediction model to reduce the incidence of percutaneous liver biopsy bleeding in children.  Methods From the hospital's electronic medical record system, clinical data of the study subjects were obtained during their hospitalization. Continuous variables were described using the median (interquartile range), while categorical variables were described using frequencies, proportions, and rates. Feature variables were screened using Lasso regression, and the data were divided into training and validation sets in a 7:3 ratio. Variables with statistically significant differences were included in a binary logistic regression model, and a risk prediction model was constructed using stepwise bidirectional regression. The model was visualized using a nomogram and internally validated. The ROC curve was used to assess the model's discriminative ability, the calibration curve to evaluate its calibration, and the decision curve analysis to assess its clinical decision-making capability. Results The incidence of bleeding in this study was 13.3%, most of which were minor and did not cause serious complications. Variables with meaningful Lasso regression coefficients were included in the multivariate logistic regression analysis, and the stepwise bidirectional regression ultimately yielded seven independent influencing factors: Pre-Corticosteroid, Post Liver Transplantation, Needle Depth, ALT, PT, PLT, and GPR. These factors will be used to construct a prediction model for percutaneous liver biopsy bleeding in children. In this study, the training set AUC was 0.720, with a 95% CI of 0.675-0.765, and the validation set AUC was 0.700, with a 95% CI of 0.633-0.767. Conclusion This study created and internally tested a bleeding prediction model for children undergoing percutaneous liver biopsy, demonstrating moderate discriminative ability. Additional optimization and external validation are necessary. Expanding research with larger, multi-center datasets is crucial to enhancing the model's predictive accuracy and clinical applicability.

Background and Objectives: The development of liver fibrosis as a consequence of continuous inflammation represents a turning point in the evolution of chronic liver diseases. The recent developments of artificial intelligence (AI) applications show a high potential for improving the accuracy of diagnosis, involving large sets of clinical data. For this reason, the aim of this systematic review is to provide a comprehensive overview of current AI applications and analyze the accuracy of these systems to perform an automated diagnosis of liver fibrosis. Materials and Methods: We searched PubMed, Cochrane Library, EMBASE, and WILEY databases using predefined keywords. Articles were screened for relevant publications about AI applications capable of diagnosing liver fibrosis. Exclusion criteria were animal studies, case reports, abstracts, letters to the editor, conference presentations, pediatric studies, studies written in languages other than English, and editorials. Results: Our search identified a total of 24 articles analyzing the automated imagistic diagnosis of liver fibrosis, out of which six studies analyze liver ultrasound images, seven studies analyze computer tomography images, five studies analyze magnetic resonance images, and six studies analyze liver biopsies. The studies included in our systematic review showed that AI-assisted non-invasive techniques performed as accurately as human experts in detecting and staging liver fibrosis. Nevertheless, the findings of these studies need to be confirmed through clinical trials to be implemented into clinical practice. Conclusions: The current systematic review provides a comprehensive analysis of the performance of AI systems in diagnosing liver fibrosis. Automatic diagnosis, staging, and risk stratification for liver fibrosis is currently possible considering the accuracy of the AI systems, which can overcome the limitations of non-invasive diagnosis methods.

Objective This study aimed to analyze the characteristics of patients undergoing percutaneous liver biopsies and investigate the pathological manifestations of four major liver diseases across different age groups. Methods A retrospective analysis was conducted of 4,717 liver pathology reports from 2009 to 2024. The study population comprised 4,188 patients who underwent liver biopsies, with 408 patients receiving two biopsies and 50 patients who underwent three or more procedures. Most of biopsies (4,171) were performed between 2013 and 2023. Disease categorization, temporal distribution, and pathological manifestations across different age groups were assessed employed descriptive statistics, trend analyses, and graphical representations. Results Since 2020, a gradual increase has been observed in the proportion of cases involving concurrent hepatitis B complicated by metabolic-associated steatohepatitis (MASLD), along with an elevation in the incidence of MASLD alone. Pathological manifestations varied considerably across different age groups. Patients with hepatitis B complicated by MASLD exhibited disease exacerbation in middle age, with both liver inflammation and fibrosis grading worsening as age advanced. Furthermore, within the same age bracket, the severity of inflammation and the extent of fibrosis were more pronounced in cases where chronic hepatitis B was combined with MASLD compared to those with isolated chronic hepatitis B or MASLD. Conclusion This study offers a comprehensive analysis of the characteristics and pathological manifestations of patients who underwent percutaneous liver biopsies over a 15-year period. The findings underscore the varying pathological manifestations across different age groups for the four major liver diseases and emphasize the necessity for tailored therapeutic interventions, particularly for patients with concurrent hepatitis B and MASLD, as antiviral therapy alone may be inadequate. Further research is warranted to explore optimal management strategies for these patient subpopulations. Highlights Comprehensive Patient Characterization for Liver Biopsy: Over a 15-year period spanning from 2009 to 2024, our study meticulously analyzed 4,717 liver pathology reports, revealing a significant male preponderance (63.37%) and a peak age distribution within the range of 31–50 years. Notably, 4,188 patients underwent liver biopsy, with 408 receiving two procedures and 50 undergoing three or more, including one remarkable case where a patient underwent eight biopsies over the 15-year span. This underscores the diverse patient cohorts and extensive follow-up included in our analysis. Shifting Disease Landscape in Liver Biopsy: From 2013 to 2023, the vast majority (96.26%) of liver biopsies focused on four primary diagnoses: chronic hepatitis B, Hepatitis B with metabolic-associated steatohepatitis (MASLD), liver dysfunction, and standalone MASLD. Notably, an increasing trend emerged, with Hepatitis B + MASLD surpassing Hepatitis B alone and standalone MASLD becoming the third most prevalent diagnosis. This highlights evolving disease patterns and research interests within the field. Age-dependent Pathological Heterogeneity: Detailed pathological analysis revealed age-specific variations in fibrosis (F) grades, inflammation (A) grades, and steatosis (S) grades. For instance, patients with MASLD aged > 60 exhibited the most severe inflammation (A) and fibrosis (F) grades, while steatosis (S) peaked before 35 years. In cases of Hepatitis B, inflammation (A) peaked in the 21–25 age group, whereas fibrosis (F) peaked after 60 years. Patients with Hepatitis B + MASLD experienced exacerbated inflammation (A) and fibrosis (F) with advancing age, emphasizing the importance of age-tailored diagnostic and therapeutic strategies. Efficacy of Treatment Strategies in Chronic Hepatitis B Assessed through Serial Biopsies: Among 50 patients undergoing ≥ 3 biopsies, we compared two treatment approaches: antiviral therapy with primary disease management (Scheme a) versus long-term liver protection and symptomatic treatment (including herbal antifibrotic agents, Scheme b). Surprisingly, despite antiviral therapy, some patients in Scheme a showed slow progression of inflammation and fibrosis. This unexpected finding underscores the potential value of comprehensive liver protection strategies in managing chronic hepatitis B, warranting further investigation into the optimization of treatment approaches.

Non-alcoholic fatty liver disease and non-alcoholic steato-hepatitis are common in patients undergoing bariatric surgery. Non-alcoholic steato-hepatitis can progress to cirrhosis of the liver and hepatocellular carcinoma. Non-invasive methods of diagnosing non-alcoholic steato-hepatitis are not as accurate as liver biopsy, and bariatric surgery presents a unique opportunity to carry out a simultaneous liver biopsy. Routine liver biopsy can help early and accurate diagnosis of obesity-associated liver conditions. This has led some surgeons to argue for routine liver biopsy at the time of bariatric surgery. However, most bariatric surgeons remain unconvinced and liver biopsy is currently not routine practice with bariatric surgery. This review examines published scientific literature to ascertain the usefulness of routine liver biopsy at the time of bariatric surgery.

Background and Aims Endoscopic ultrasound-guided liver biopsy (EUS-LB) is considered to be safe and effective. Commonly a 19-G fine-needle aspiration or biopsy needle is used. But, the results vary with different techniques that are used. Herein, we report the results of liver biopsy with a single-pass, three actuations (1:3) using the slow-pull technique. Methods In this prospective study, 50 consecutive patients with indications for liver biopsy underwent EUS-LB with a 19-gauge fine-needle biopsy (FNB) needle from both right and left lobes. The primary outcome was the adequacy of the specimen for histological diagnosis. Total specimen length (TSL), longest specimen length (LSL), complete portal tracts (CPTs) and comparison of these outcomes between the left lobe and right lobe specimens were secondary outcomes. Adverse events (AEs) were also measured during this study. Results Adequate tissue for histological diagnosis was obtained in all 50 patients (100%). The median number of CPTs was 32.5 (range, 11–58), while the median of TSL was 58 mm (range, 35–190) and the median LSL was 15 mm (range, 5–40). There was no significant difference in CPTs, TSL and LSL between left and right lobe biopsies. There was no major complication; one of the patients (2%) had bleed from the duodenal puncture site, which was managed endoscopically without the need for blood transfusion. Conclusions Endoscopic ultrasound-guided liver biopsy using a 19-gauge Franseen tip needle with a single pass, three actuation (1:3) and slow-pull technique provides adequate tissue yield and has a good safety profile.

Aim Although major complication rates following percutaneous liver biopsy (PLB) have been reported to be higher in children than in adults, scarce data are available regarding pediatric patients stratified by native and transplanted liver. We aimed to assess the factors associated with major complications after percutaneous biopsy of native or transplanted liver using a nationwide inpatient database. Methods Using the Japanese Diagnosis Procedure Combination database, we retrospectively identified pediatric patients who underwent PLB between 2010 and 2018. We described major complication rates and analyzed factors associated with major complications following PLB, stratified by native and transplanted liver. Results We identified 3584 pediatric PLBs among 1732 patients from 239 hospitals throughout Japan during the study period, including 1310 in the native liver and 2274 in the transplanted liver. Major complications following PLB were observed in 0.5% (n = 18) of the total cases; PLB in the transplanted liver had major complications less frequently than those in the native liver (0.2% vs. 1.0%, p  = 0.002). The occurrence of major complications was associated with younger age, liver cancers, unscheduled admission, anemia or coagulation disorders in cases with native liver, while it was associated with younger age alone in cases with transplanted liver. Conclusions The present study, using a nationwide database, found that major complications occurred more frequently in pediatric cases with native liver and identified several factors associated with its major complications.