EFFICACY AND SAFETY OF ENDOSURGICAL BIOPSY IN CHILDREN WITH CHRONIC LIVER DISEASE

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Abstract

Background. A variety of pathomorphological manifestations of chronic liver diseases (CLD) in children necessitates a sufficient size for a reliable morphological assessment of the size of the hepatobioptate. Marked fibrotic changes in liver tissue and the presence of a high incidence of hemostatic disorders increase the risk of complications during a biopsy. In view of this, the liver biopsy method should be selected in accordance with the amount of biopsy material necessary for an accurate verification of the diagnosis, being the most effective and at the same time the safest with respect to the risks of complications both during the biopsy and in the postoperative period. Materials and methods. The one-center bi-directional (retro- and prospective) study included 175 patients with CLD: 75 children who made up the main group had a liver biopsy by edge resection, and 100 patients with CLD included in the comparison group had previously undergone a biopsy. A comparative analysis of the duration of the biopsy, the presence and nature of the complications, the number of portal tracts contained in the obtained samples, the number of fragmented and uninformative biopsy samples during the behavior of the puncture biopsy and marginal resection of the liver tissue under laparoscopic control was performed. Results. Hepatobioptate marginal resection took an average time of 21.7 minutes. No complications were noted. A puncture biopsy took an average of 19.4 minutes. In four cases, the development of complications was noted (two cases being the bleeding from the puncture site, one case being a violation of the integrity of the gallbladder wall with the development of local biliary peritonitis, the development of pneumothorax due to lung damage). According to the Mann - Whitney criterion, statistically significant differences in the number of portal tracts in the main and comparison groups were revealed (p=0.000). The number of portal tracts during the regional resection of the hepatobioptate averaged 93, while those happened during the puncture averaged 5. The information content of the biopsy samples in the main group was 100%. Fragmentation of biopsy material was not noted. In the comparison group, the informative value of biopsy samples was 86%, 20% of biopsy samples were fragmented.

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About the authors

Polina V. Khrolenko

National Medical Research Center of Children’s Health

Email: polinakhrolenko@gmail.com

Sergei P. Yatsyk

National Medical Research Center of Children’s Health

Elena Yu. D'yakonova

National Medical Research Center of Children’s Health

Andrei N. Surkov

National Medical Research Center of Children’s Health

Elena L. Tumanova

Pirogov Russian National Research Medical University

Aleksei A. Gusev

National Medical Research Center of Children’s Health

Kirill A. Kulikov

National Medical Research Center of Children’s Health

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