Transjugular liver biopsy (TJLB) is considered an inferior biopsy, used when percutaneous
liver biopsy (PLB) is contraindicated. According to recent literature, specimens with
6 complete portal tracts (CPTs) are needed for histological diagnosis of chronic liver
disease but 11 CPTs to reliably stage and grade. Mean CPT number in PLB series is
7.5; more passes increase complications. Sixty-four series reporting 7649 TJLBs were
evaluated for quality of specimen and safety. Major indications were coagulation disorders
and/or ascites. Success rate was 96.8%. Fragmentation rate was 34.3%, not correlating
with length or diagnostic adequacy. With a mean of 2.7 passes, mean CPT number was
6.8. Histological diagnosis was achieved in 96.1% of TJLBs, correlating with length
(p=0.007) and CPT number (p=0.04). Tru-Cut specimens had a mean CPT number of 7.5
and, compared to Menghini specimens, were longer (p<0.008), less fragmented (p<0.001)
and more diagnostic (p<0.001). Thinner needles (>16-G) provided significantly longer
and less fragmented specimens. Minor and major complication rates were 6.5% and 0.56%,
respectively, and increased in children, but not with additional passes. In adults,
mortality was 0.09% (haemorrhage 0.06%; ventricular arrhythmia 0.03%). TJLB is safe,
providing specimens qualitatively comparable to PLB, and may improve further using
> or = 18-G Tru-Cut needle and >3 passes.