RESULTS
A total of 569 biopsies were performed during the study period. Due to a lack of data in the medical records, 37 cases were excluded. Eight subjects underwent two biopsies, so the study involved 532 biopsies in 524 patients (55.3% male) with a median age of 49 years (range: 13 to 74), as shown in Table 1.
Regarding laboratory tests, INR value and platelets count were available in 530 procedures. The median and range (minimal – maximum) were 1.01 (0.84 – 1.55) and 200,000/mm3 (48,000 – 474,000/mm3 Almost 40% had cardiovascular comorbidities, around 18% had overweight or obesity and 2.1% had chronic kidney disease. Half of the studied population had no comorbidities (Table 1).
HCV chronic infection assessment was the major indication for PLB (47.0%), followed by AIH / cholestasis (12.6%) and MAFLD (12.1%). The amount of HCV-related procedures has sharply reduced. On the other hand, the number of MAFLD-related biopsies has progressively raised over the years, as shown in Figure 1.
The median number of needle passes was 1 (ranging from 1 to 4). PLB-related pain was reported in 53.6% of the studied population. To relieve it, dipyrone was administered in 40.2% of patients, tramadol in 3.7%, and both medications in 8.1%. Eight patients (1.6%) that complained of pain did not require any medication. The female gender was associated with a higher complaint of pain (p=0.0143). There was no significant influence of other clinical and laboratory variables in the occurrence of pain (age, comorbidities, platelets count, INR, and number of needle passes). AEs occurred in 87/532 biopsies (16.4%); they were mild in 76 (14.3%) and serious in 11 (2.1%) procedures.
The main mild AEs (n=76) were high blood pressure (32/532 – 6.0%), headache (3.6%), nausea/vomiting (2.4%), low blood pressure (1.5%), and hypoglycemia (0.2%), as shown in Table 2. The management was oral captopril, venous dipyrone, venous metoclopramide, venous crystalloid, and glucose infusion, respectively. Regarding serious AEs (n=11), 5 patients had perihepatic fluid on US, 4 had subcapsular bleeding, and 2 had right-sided hemothorax (Table 2). Ten patients (1.9%) were admitted to the hospital due to the following conditions: perihepatic fluid on US examination (n=4), subcapsular bleeding (n=2), hemothorax (n=2), low blood pressure with nausea/vomiting (n=1) and intense pain at the biopsy site (n=1). No one patient required surgical treatment and there were no deaths, as shown in Table 2. There was no association between the occurrence of mild or serious AEs and the studied variables (clinical, laboratory, and procedure-related). Renal function was normal in all the patients that developed bleeding.