Liver Biopsy: Modified Menghini and Trucut Needles for Fibrin Sealing of the Biopsy Channel: Clinical Experience

Abstract

Histologic investigation of liver tissue obtained by percutaneous needle biopsy remains the mainstay in the diagnosis of liver disease. Impaired blood clotting or thrombocytopenia precludes percutaneous liver biopsy for the danger of sometimes life-threatening hemorrhage as the most serious complication. The feasibility of plugging the intrahepatic needle track with fibrin sealant to minimize the risk of bleeding has been shown. The advantage of the method presented here is that biopsy and sealing can be performed as a one-step procedure, thus shortening the time necessary and minimizing the risk of complications. We considered laparoscopic control most reliable to optimize handling of the double-channel needles and to assess the reliability of fibrin plugging for the “blind” percutaneous approach. In 27 patients a modified Menghini needle and in 10 patients a modified Trucut needle were tested. In our experience the handling of the modified Trucut needle proved easier. There was, however, no significant difference in the length of the biopsy core obtained with the two needles (16 ± 8.6 mm Menghini needle and 15.75 ± 7.1 mm Trucut needle), resulting from the larger diameter of the Menghini needle (1.8). The thin trickle of bleeding observed around the plug in a few patients was without clinical significance, reflecting the prolonged coagulation time in these patients. In summary, in the hands of an experienced investigator the combined biopsy-plugging device is a safe and reliable tool for obtaining liver tissue in patients with impaired blood coagulation. As a one-step procedure it can be performed quickly, thus increasing safety by diminishing the need for patient cooperation.