Percutaneous Liver Biopsy Practice Patterns Among Pediatric Gastroenterologists in North America

Abstract

Objectives: To document current percutaneous liver biopsy (PLB) practices among pediatric gastroenterologists. Materials and Methods: A total of 699 practicing pediatric gastroenterologists received an e-mail invitation to participate in a Web-based survey. Our primary outcome was whether or not pediatric gastroenterologists reported currently performing PLB. We queried a number of practice preferences and potential factors that affect preferences among all of the participants. Results: Of 474 participants who opened the e-mail, 317 (67%) completed the survey. Of those, 35% said that they performed no PLBs in an average month, instead referring patients who require the procedure to interventional radiologists. Patient safety and desire for ultrasound guidance were rated the most important reasons for referral. Adjusted analysis showed that pediatric gastroenterologists in academic settings were twice as likely to report performing PLB as those practicing elsewhere (P = .003). The interval since fellowship training was not associated with PLB performance in crude or adjusted analyses. Among those participants who did report performing PLB, substantial variation was found in preferred biopsy device, use of ultrasound assistance, and routine hospital admission post-PLB. No practice preferences were found to be associated with routine admission. Conclusions: Many pediatric gastroenterologists report systematically and rationally referring children to interventional radiologists for PLB, rather than performing the procedure themselves. Crude numbers suggest that many who do not perform PLB are in academic practice settings, where fellowship training is presumably affected. Those pediatric gastroenterologists who do report performing PLB vary greatly in their preprocedure, patient disposition, and postprocedure routines.