Bleeding management in computed tomography-guided liver biopsies by biopsy tract plugging with gelatin sponge slurry

Abstract

To evaluate the safety and impact of biopsy tract plugging with gelatin sponge slurry in percutaneous liver biopsy. 300 consecutive patients (158 females, 142 males; median age, 63 years) who underwent computed tomography-guided core biopsy of the liver in coaxial technique (16/18 Gauge) with and without biopsy tract plugging were retrospectively reviewed (January 2013 to May 2018). Complications were rated according to the common criteria for adverse events (NCI-CTCAE). The study cohort was dichotomized into a plugged (71%; n = 214) and an unplugged (29%; n = 86) biopsy tract group. Biopsy tract plugging with gelatin sponge slurry was technically successful in all cases. Major bleeding events were only observed in the unplugged group (0.7%; n = 2), whereas minor bleedings (4.3%) were observed in both groups (plugged, 3.6%, n = 11; unplugged, 0.7%, n = 2). Analysis of biopsies and adverse events showed a significant association between number of needle-passes and overall (P = 0.038; odds ratio: 1.395) as well as minor bleeding events (P = 0.020; odds ratio: 1.501). No complications associated with gelatin sponge slurry were observed. Biopsy tract plugging with gelatin sponge slurry is a technically easy and safe procedure that can prevent major bleeding events following liver biopsy.

Figure 1

Inclusion and exclusion criteria of the study cohort.

Figure 2

CT-guided liver biopsy and post-interventional sonography. (a) Axial slice of the pre-interventional CT. Target lesion in segment 5/6. Arterial phase. (b,c) Correlating axial slices of the lesion in late portal and delayed phase. Adequate biopsy tract length. (d) Biopsy performed with a 16-G core needle coaxial system and an 18-G cutting needle. Intralesional location. (e) Post-interventional non-enhanced CT. Percutaneous tract embolization by gelatin sponge slurry. (f) Post-interventional ultrasound. Adequate distribution of hyperechoic gelatin foam slurry. No ascites. No haematoma.

Figure 3

Preparation of gelatin sponge slurry. (a) Cutting gelatin foam in several small squares (5 x 5 mm). (b,c) Mixing 2 ml of compressed foam with 4 ml of 0.9% NaCl solution. (d) Viscous embolizate of gelatin sponge slurry.