Transjugular liver biopsy

A 34-year-old male patient who first presented to the integrated liver team with complaints of altered liver function and coagulopathy. The patient reported a history of chronic alcohol consumption for the past 10 years.

The patient was referred for an ultrasound abdomen which showed the liver to have an altered echotexture with surface irregularity and free fluid in the peritoneum. The patient was referred to the Intervention Radiology team for a transjugular liver biopsy (TJLB) in view of coagulopathy and free fluid in the pelvis. The patient was taken up for TJLB, a right internal jugular vein access was achieved under USG guidance and a 9F sheath placed, the right hepatic vein was selectively cannulated using a 5F Cobra Catheter and Terumo wire. A long 7F sheath with metal cannula was exchanged. A 18G biopsy needle (60 cm and 20mm throw) was inserted through the long 7F sheath up to the proximal mid third of the hepatic vein. Using ultrasound guidance the parenchymal core was acquired, following which an acquisition check venogram was performed which showed the biopsy tract.

Transjugular liver biopsy is an alternative and a safe route to perform liver biopsy over percutaneous liver biopsy (PB) in patients contraindicated for PB. Weiner et al. first described the procedure [1, 2]. Percutaneous liver biopsy is a very common procedure in most instances with patients because of the acquisition of adequate samples and its simple technical nature. Both procedures acquire the same quality of tissue samples. The transvenous approach completely avoids the capsular and peritoneal penetration. The procedure is indicated in patients mainly with ascities or coagulopathy. The procedure has a technical success of 96.8% [3]. Minor and major complication rates are 0.56% and 6.5% [3]. The procedure can be performed in the paediatric age group, however, after giving general anaesthesia, and the procedure is associated with higher complication rates in this age group. The procedure has gained more technical advancement, accuracy and reduced radiation dose recently with the use of ultrasound guidance and radiation dose reduction special surgical drapes.
Transjugular liver biopsy is a highly effective procedure in patients contraindicated for percutaneous approach.

Written informed patient consent for publication has been obtained.