P0944 - A Retrospective Review of Outcomes and Complications of Ultrasound-Guided Percutaneous Liver Biopsies Performed at a Large Gastroenterology Fellowship Program

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Presenting Author(s)

MS

Matthew Schwartz, MD (he/him/his)

Brooke Army Medical Center
San Antonio, TX

Matthew Schwartz, MD¹, Ted A. Spiewak, DO², John Gancayco, MD, FACG¹, Geoff Bader, MD¹
¹Brooke Army Medical Center, San Antonio, TX; ²SAUSHEC, Fort Sam Houston, TX

Introduction: Percutaneous liver biopsy is an important diagnostic tool but is invasive and associated with potentially serious complications. The most frequently cited complication rates are based on retrospective studies performed over 30 years ago. Given changes in liver biopsy technique and demographics in recent decades, we sought to examine risk factors and incidence of complications associated with ultrasound (US)-guided percutaneous liver biopsy in a large gastroenterology (GI) fellowship program.

Methods: A review of 186 US-guided percutaneous liver biopsies performed in the outpatient setting by GI fellows from (July 1, 2019 to September 1, 2022) at a tertiary care academic medical center. Patients were identified based on Current Procedural Terminology codes for percutaneous liver biopsy with needle. Demographic information, indication, laboratory data, medical comorbidities, and proceduralist training level were evaluated in relation to incidence of complications and biopsy success rates.

Results: In total, 174 patients underwent US-guided percutaneous liver biopsy with 186 procedures performed. Adequate tissue was obtained in 97.8% of cases. The major complication rate was 21%, of which 84.6% were due to procedural site pain. The rate of other major complications was 1.6%. Only 1% of biopsies required post-procedural hospitalization and no deaths occurred. Potential risk factors including patient age (p = 0.14), ethnicity (p = 0.47), BMI (p = 0.57), underlying fibrosis (p = 0.90) or etiology of liver disease did not impact outcomes. INR (p = 0.47), hemoglobin (p = 0.61), and platelet count (p = 0.62) were not associated with an increase in complications. No difference in outcomes was identified between procedures following endoscopic procedures or when comparing proceduralist training (p = 0.58).

Discussion: In our study, supervised GI fellows performed US-guided percutaneous liver biopsies with technical success and complication rates mirroring historical trends despite changes in technique and patient demographics in recent decades. GI fellow training level was not a risk factor for procedure complications or failure. The majority of adverse events were biopsy site pain requiring single low dose analgesics. Traditional serologic markers did not predict increased risk of complications. This study emphasizes that US-guided percutaneous liver biopsy remains a safe, effective and teachable procedure in GI fellowship training.

	Population (total)	No complications	Major Complications	Minor Complications	Associated p-value
Average age	54.4	55.3	51.4	52.6	0.14
Gender - male	106	83	18	5	0.19
Gender - female	80	53	21	6	0.19
Race - White	122	90	25	7	0.47
Race - Black	19	12	5	2	0.47
Ethnicity - Hispanic	50	43	5	2	0.47
Average BMI	32.6	32.0	33.6	30.87	0.57
ASA (average)	2.45	2.43	2.49	2.55	0.69
Hemoglobin	14.4	14.4	14.2	14.1	0.61
Platelets	235.7	239.9	222.2	231.5	0.63
INR	1.02	1.02	1.02	1.05	0.47
Indication: Initial hepatitis evaluation	128	96	23	6	0.24
Indication: Elevated kPa on elastography	127	98	23	6	0.19
Indication: Repeat evaluation of hepatitis	60	41	17	2	0.17
Indication: Performed for research monitoring	25	17	8	0	0.09
PGY-4 performed	61	53	15	5	0.58
PGY-5 performed	91	61	17	4	0.58
PGY-6 performed	30	18	7	2	0.58
Staff performed	4	4	0	0	0.58
Single pass biopsy - 14 gauge needle	153	110	33	10	0.61
Two pass biopsy - 16 gauge needle	33	26	6	1	0.61
No concurrent endoscopy	155	113	33	9	0.97
Concurrent EGD without colonoscopy	10	5	3	2	***
Concurrent colonoscopy without EGD	11	9	2	0	***
Concurrent EGD and colonoscopy	10	9	1	0	***

Table: *** unable to reliably interpret due to limited sample size. PGY represents 'post graduate year', or level of fellow training
p-value represents chi-squared analysis comparing “major”, “minor”, and “no observed” complication outcomes

Disclosures:

Matthew Schwartz indicated no relevant financial relationships.

Ted Spiewak indicated no relevant financial relationships.

John Gancayco indicated no relevant financial relationships.

Geoff Bader indicated no relevant financial relationships.

Matthew Schwartz, MD¹, Ted A. Spiewak, DO², John Gancayco, MD, FACG¹, Geoff Bader, MD¹. P0944 - A Retrospective Review of Outcomes and Complications of Ultrasound-Guided Percutaneous Liver Biopsies Performed at a Large Gastroenterology Fellowship Program, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.