**1. Introduction**

Liver biopsy remains a golden standard in the evaluation of various liver diseases. It is one of the most specific test allowing to assess the severity of various liver diseases. Clinical evaluation may be inadequate as chronic liver diseases could be asymptomatic for a long pe‐ riod of time. The routinely used laboratory test may be irrelevant, as diffuse changes may possibly be present in the liver in spite of liver function test being within reference values. Percutaneous biopsy allows to obtain a tissue specimen suitable for pathological assessment. Liver biopsy is an important procedure in diagnosing liver diseases in infants and children as it often provides diagnostic information not possible to obtain by other methods. There‐ fore, liver biopsy is considered to be a golden standard in the diagnostics and follow-up of the patients with chronic diffuse hepatopathies. The role of the liver biopsy is to confirm the diagnosis of chronic hepatitis, assess the necroinflamatory activity (grading) and the severi‐ ty of fibrosis (staging), confirm the presence of cirrhosis. Other hepatopathies may be ex‐ cluded as well as associated diseases using this method [1].

The size of liver sample varies from 1 to 4 cm in length and 1.2 to 1.8 mm in diameter. Biop‐ sy specimen represents 1/50,000 of the total mass of the liver, therefore the procedure carries the risk of sampling error. The specimen should be sufficient in length (2-2.5 cm) and num‐ ber of portal spaces (at least 11). The fragmentation of the specimen should be avoided [2]. Liver assessment is also affected by an interpretative error and intraobserver variability of histological interpretation. Moreover, liver biopsy is an invasive procedure carrying the risk

© 2012 Mania et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2012 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

of certain complications including pain, bleeding, pneumothorax, puncture of bile ducts or the gall bladder.

bladder, the lung, right kidney and large vessels. Immediately after the procedure ultra‐ sound examination was performed searching for potential complications such as accidental puncture or bleeding. In the case of blind biopsied ultrasound examination was performed by radiologists in situations where complications were suspected basing on clinical symp‐ toms. All patients were monitored 24 hours after the procedure in the department for vital

Safety and Reliability Percutaneous Liver Biopsy Procedure in Children with Chronic Liver Diseases

http://dx.doi.org/10.5772/52619

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Histological evaluation was performed using Ishak scoring system for grading and staging.

Categorical variables were compared using Fisher's exact test or chi-square test were appro‐

**Figure 1.** Number of liver biopsy performed in the Department of Infectious Diseases and Child Neurology due to vari‐ ous reasons in years 2005-2012 (until July) CHC- chronic hepatitis C, CHB – chronic hepatitis B, NAFLD – non-alcoholic

Liver samples were obtained in all children. Adequate sample size was not obtained in the case of 5 children - 2 samples were to short and did not contain the adequate number of por‐ tal spaces, one sample was fragmented. Four inadequate samples resulted from the blind liver biopsy and 1 was obtained by the ultrasound guided procedure (p=0.21). No significant adverse events were observed. No clinical signs of hemorrhage, no cases of pneumothorax, puncture of the gallbladder nor severe infections were observed. Larger bile ducts were punctured in 4 cases – all undergoing blind procedure (p=0.07). 12 patient were complaining on pain in the right upper quadrant of the abdomen following the procedure that required more intensive analgesics – 3 undergoing ultrasound guided procedure, 9 having blind liver

fatty liver disease, HUO – hepatitis/hepatomegaly of unknown origin, AIH – autoimmune hepatitis

priate. Result with p value <0.05 were considered statistically significant.

signs, pain and other consequences.

**3. Results**

Repeating samples in different time intervals are useful in monitoring the efficacy of treat‐ ments. Many patients are, however, reluctant to experience repeated biopsies, which limits the ability to monitor disease progression and treatment effects. [3].

Due to the limitations of the procedure many non-invasive techniques were developed such as single serological markers, panels of different markers, imaging techniques and elastogra‐ phy [4]. None of the non-invasive methods is suitable and reliable enough to entirely substi‐ tute the liver biopsy. Non-invasive techniques are very helpful in the detection of severe lesions. However, results obtained from patients with intermediate lesions very often over‐ lap between different categories of staging. Nevertheless non-invasive methods are useful in situations where contraindications to liver biopsy do not allow to perform the procedure.

Liver biopsy can be percutaneous, transjugular or laparoscopic. Percutaneous liver biopsy can be blind, ultrasound- guided or ultrasound assisted. Various approaches differ in the number of potential complications and require various equipment. Ultrasound guidance al‐ lows safer intercostal approach and may be useful in the evaluation of relative position of the liver, gall bladder, kidneys and lungs. The technique reduces the risk of hemothorax and pneumothorax and puncture of the gall bladder.

The aim of this study was to evaluate safety and reliability of the liver biopsy in children in relation to obtained results and potential complications.
