Can liver biopsy be avoided in children with chronic liver disease?
In pediatric patients with chronic liver diseases diagnosed in noncirrhotic states, the examination and interpretation of clinical presentation by senior doctors, as opposed to residents, may reduce the need for diagnostic liver biopsy in some cases, according to a study.
In this observational epidemiological study, 37 cases including Wilson disease (n = 8), autoimmune hepatitis (n = 4), secondary hemochromatosis (n = 4), chronic hepatitis B (n = 3), chronic hepatitis C (n = 2), non-alcoholic steatohepatitis (n = 2), progressive familial intrahepatic cholestasis (n = 2), extrahepatic biliary atresia (n = 2), Alagille syndrome (n = 1), galactosemia (n = 1), Gaucher disease (n = 1), Niemann-Pick disease (n = 1), Budd-Chiari syndrome (n = 1), and an inconclusive diagnosis in 5 children, were analyzed.
Overall, specialist consultant and super specialist combined were found to have ordered more frequent relevant investigations compared with the senior resident and junior resident together. In the junior tier, irrelevant tests were ordered significantly more than senior tier doctors.
“The clinicohistological correlation of an etiological diagnosis significantly differed between the junior and senior ranks of physicians,” the authors said, noting the ideal clinical expertise could result in 78.3% of the study populating not needing a live biopsy for etiological diagnosis.
Samanta T, Basu R, Purkait R, et al. Clinicohistological correlation of etiological spectrum of chronic liver disease diagnosed during noncirrhotic stages in children: Can need of liver biopsy be obviated? JGH Open. 2020 Oct 30;5(1):20-27. doi: 10.1002/jgh3.12441. PMID: 33490609; PMCID: PMC7812483.