背景:经皮肝活检是评估肝病的金标准。在凝血障碍患者中,腹水,移植后,和高血管性肿瘤,活检与不良事件(AE)风险增加相关.建议在这些情况下进行经颈静脉肝活检(TJLB),但价格昂贵且在许多中心均不可用。封堵肝活检(PLB)在这些高风险病例中提供了另一种诊断方式。
目的:分析高危病例中PLB的合并诊断结果和安全性。
方法:对1990年1月至2022年7月的各种数据库进行了文献检索,以评估PLB在高危病例中的结局。主要结果是汇集的样本充足性和AE。研究中汇总的事件发生率用总结性统计数据表示。
结果:共有17项研究(2329例患者)纳入荟萃分析。样本充分性的合并比例为98.9%(95%置信区间[CI]=98.2-99.6)。严重不良事件,大出血,和轻微的不良事件发生在0.7%(95%CI=0.1-1.3),0.4%(95%CI=0.1-0.8),11.5%(95%CI=2.4-20.6)的患者。只有一个报告的死亡率,合并发生率为0.0002%(95%CI=0.0-0.0038)。与TJLB相比(5项研究,n=336),样本充分性(比值比[OR]=2.34,95%CI=0.83~6.58)和严重AE风险(OR=0.47,95%CI=0.173~1.31)均无差异.
结论:PLB可以安全地用于有凝血病和/或腹水的患者,具有较高的样本充足率和较低的不良事件发生率和死亡率。
BACKGROUND: Percutaneous liver biopsy is the gold standard test for the assessment of liver disease. In patients with coagulopathy, ascites, post-transplantation, and hypervascular tumors, biopsy is associated with increased risk of adverse events (AEs). Transjugular liver biopsy (TJLB) is recommended in these conditions but is expensive and unavailable at many centers. Plugged liver biopsy (PLB) provides an alternate diagnostic modality in these high-risk cases.
OBJECTIVE: To analyze the pooled diagnostic outcome and safety of PLB in high-risk cases.
METHODS: A literature search of various databases from January 1990 to July 2022 was conducted for studies evaluating the outcome of PLB in high-risk cases. The primary outcomes were pooled sample adequacy and AEs. Pooled event rates across studies were expressed with summative statistics.
RESULTS: A total of 17 studies (2329 patients) were included in the meta-analysis. The pooled proportion of sample adequacy was 98.9% (95% confidence interval [CI]=98.2-99.6). Severe AEs, major bleeding, and minor AEs were seen in 0.7% (95% CI=0.1-1.3), 0.4% (95% CI=0.1-0.8), and 11.5% (95% CI=2.4-20.6) of the patients. There was only one reported mortality, giving a pooled incidence of 0.0002% (95% CI=0.0-0.0038). Compared to TJLB (5 studies, n = 336), there was no difference in either sample adequacy (odds ratio [OR]=2.34, 95% CI=0.83-6.58) or risk of serious AEs (OR=0.47, 95% CI=0.173-1.31).
CONCLUSIONS: PLB can be safely performed on patients with coagulopathy and/or ascites with high sample adequacy rates and low incidence of AEs and mortality.