Liver biopsy in children: indications, contraindications, complications, information content. A review

Liver biopsy in pediatric patients enables the determination of the morphological characteristics of pathological processes in various clinical scenarios, facilitates the selection of optimal treatment strategies, and supports the monitoring of therapeutic efficacy. This review aims to present current approaches to pediatric liver biopsy and the application of its findings. A literature search was performed in the PubMed and CyberLeninka databases using the keywords: biopsy, liver, children, fibrosis, and hepatitis, covering the period from 1985 to 2025. Studies reporting practical applications of liver biopsy in children were included. The review summarizes the main current indications (such as neonatal cholestasis, autoimmune hepatitis, Wilson-Konovalov disease, and metabolic-associated steatohepatitis), contraindications (absolute and relative), biopsy techniques (percutaneous, transvenous, and occluder-assisted), and complications associated with this invasive diagnostic procedure in children (including pain, bleeding, intrahepatic and subcapsular hematoma, hemobilia, transient bacteremia, and biliary peritonitis). Accurate diagnosis requires a comprehensive evaluation of medical history, clinical presentation, laboratory and instrumental findings, and biopsy results. Optimal biopsy outcomes are achieved when the hepatologist provides complete clinical information and clearly defines diagnostic objectives for the pathologist, in accordance with evidence-based medicine principles. Despite potential risks, liver biopsy remains among the most informative diagnostic methods for pediatric liver diseases, enabling timely identification of pathology and effective intervention. The majority of studies indicate that, when properly performed, liver biopsy in children is associated with a high safety profile and a low incidence of early and late complications.