A small retrospective study (R Bolia et al. JPGN 2017; 65: 86-88) with 497 patients (626 biopsies) found that all complications were identified within 8 hours. Thirty (48%) had complications, with a subcapsular hematoma being most common (n=14). Less common adverse events included fever (n=5), skin site ooze (n=3), intraperitoneal bleeding (n=3), hemobilia (n=2), anaphylaxis to gelfoam (n=2), and sepsis (n=1). In this study, the majority of biopsies were performed by interventional radiology (n=492); though, the complication rate was similar in both groups.
The authors conclude that their data support the outpatient liver biopsies in children.
My take: I disagree with the authors’ conclusion to some extent. Their population is too small to detect rare but severe complications. Our empiric practice is watch children older than 6 years of age for 6 hours and watch younger children (or others deemed at increased risk) for 24 hours.
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