Application of ultrasound-guided coaxial needle biopsy combined with gelatin sponge plugging in pediatric liver biopsy

Abstract

Purpose: The aim of this study was to assess the performance of utilizing the coaxial technique in conjunction with gelatin sponge slurry plugging for ultrasound-guided liver biopsy in children.

Methods: We conducted a retrospective study of children undergoing ultrasound-guided coaxial liver biopsy at our institution between March 2020 and March 2025. Participants were stratified into two intervention groups: those receiving gelatin sponge tract embolization vs. batroxobin administered through needle tract. Through comprehensive electronic medical record review, we systematically extracted and compared the following outcome measures: (a) overall complication rates, (b) hemorrhage rates.

Results: This study included 48 children, with 30 allocated to the gelatin sponge group and 18 to the batroxobin group. The gelatin sponge group demonstrated 9 complications (30.0%, 9/30), consisting of 5 pain events and 4 febrile episodes, while the batroxobin group experienced 6 complications (33.3%, 6/18), including 2 hemorrhage cases, 3 pain events, and 1 febrile episode. The overall complication rates showed no statistically significant difference between groups (30.0% vs. 33.3%, P = 0.809). However, a significant divergence was observed in hemorrhage incidence, with the gelatin sponge group demonstrating superior safety (0% vs. 11.1%, P = 0.044).

Conclusion: Compared to batroxobin tract injection, coaxial technique in conjunction with gelatin sponge slurry plugging significantly reduced hemorrhagic complications in liver biopsies for children, demonstrating superior safety. The finding supported its adoption as the preferred hemostatic method in children undergoing percutaneous liver biopsy.

Keywords: children; coaxial technique; gelatin sponge particle; safety; ultrasound guidance.

Figure 1

Preparation of gelatin sponge particle slurry. (A) The gelatin sponge particles were poured into a 5 ml syringe. (B) The gelatin sponge particles were uniformly mixed with 2 ml of normal saline using a three-way stopcock. (C) The gelatin sponge particle slurry was properly prepared and available for immediate intraoperative use. (D) A uniform strand of gelatin sponge particle slurry was precisely extruded from the coaxial needle assembly.

Figure 2

Ultrasound-guided plugged liver biopsy with gelatin sponge particle slurry embolization in a 17-year-old female child with indeterminate hepatic mass. The child's hemostatic profile was unremarkable, meeting all predetermined criteria for safe performance of percutaneous biopsy procedures. (A) Ultrasonographic examination revealed a large (11.3 × 8.6 cm), hypoechoic hepatic mass (indicated by arrow) located at the junction of the left and right hepatic lobes. (B) Under real-time ultrasonographic guidance, percutaneous biopsy of the hepatic mass was performed utilizing an 18-gauge cutting needle. The needle trajectory and tip position (indicated by arrow) were continuously visualized throughout the procedure. (C) The biopsy needle tract was meticulously plugged using gelatin sponge particle slurry. Ultrasound monitoring confirmed proper gelatin sponge deposition, visualized as a continuous hyperechoic linear structure (arrow) along the biopsy tract. The histopathologic analysis indicated a hepatocellular adenoma.

Figure 3

Ultrasound-guided plugged liver biopsy with gelatin sponge particle slurry embolization in a 3-year-old female child with post-transplant hepatic dysfunction. The child's laboratory results revealed elevated levels of total bilirubin (63.5 umol/L), alanine aminotransferase (592 IU/L), aspartate aminotransferase (1,445 IU/L). (A) Ultrasonography demonstrated anechoic fluid collection(arrow) localized in the surrounding region of the hepatic graft. (B) Under real-time ultrasonographic guidance, percutaneous core biopsy of the transplanted liver parenchyma was successfully performed utilizing an 18-gauge cutting needle (arrow denoted needle tip position). (C) The needle tract was plugged with gelatin sponge slurry which was shown as a hyper-echogenic line(arrow). The histopathologic analysis indicated drug-induced liver injury.

Figure 4

Flowchart showing inclusion of children undergoing percutaneous liver biopsy.

Figure 5

A severe postprocedural hemorrhage following liver biopsy in a 3-year-old child with hepatoblastoma. (A) Grayscale ultrasound demonstrated a heterogeneous hypoechoic mass (arrow) measuring approximately 8.1 × 4.5 cm in the hepatic parenchyma. (B) Color Doppler imaging revealed marked intralesional vascularity. (C) Ultrasound-guided core needle biopsy of the hepatic mass was performed under real-time visualization (arrow indicated biopsy needle trajectory). (D) On postoperative day 4, emergent ultrasound showed significant hemoperitoneum, with diagnostic paracentesis yielding non-coagulating blood (white arrow: paracentesis needle; yellow arrow: intraperitoneal hemorrhage). (E) Day 5 angiographic evaluation identified a hyper-vascular mass (arrow) in the right hepatic lobe. (F) Post-embolization angiography confirmed successful devascularization of the lesion (arrow indicated residual tumor blush reduction).