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Liver Biopsy in Pregnancy: Two Case Reports and Review of the Literature

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Abstract

The etiology of most cases of liver diseases in pregnancy can be diagnosed with a thorough history, physical examination, laboratory values, serology, and noninvasive imaging. However, atypical clinical and laboratory presentations of liver diseases/chemistries require a liver biopsy to render an accurate diagnosis in cases where the biopsy results affect the timing of delivery or impact choice of medical therapy. According to the American College of Gastroenterology, liver biopsy can be effectively and safely conducted in pregnant women. Conventional routes of performing a liver biopsy include the percutaneous, transjugular route, and surgical methods. Endoscopic ultrasound-guided liver biopsy is a recent technique that has not yet gained widespread adoption but can potentially serve as an alternative route for obtaining the liver sample. Adverse events associated with liver biopsy include abdominal pain and hemorrhage. Maternal and fetal outcomes are limited to increased risk of preterm birth and small for gestational age neonate. However, very few studies have formally evaluated the safety of liver biopsy in pregnant women. In this review, we present two successful cases of liver biopsy performed during pregnancy and summarize the most recent evidence regarding the safety and outcomes of the procedure in pregnancy to assist clinicians in their decision to perform a liver biopsy during pregnancy or postpone it until after delivery.

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Authors and Affiliations

  1. Department of Internal Medicine, The University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Kemmian D. Johnson

  2. Department of Gastroenterology and Hepatology, The University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Abhilash Perisetti

  3. The Wright Center for Graduate Medical Education, 501 S. Washington Avenue, Scranton, PA, 18503, USA

    Hemant Goyal

  4. Gastroenterology/Hepatology Staff Physician and Liver Program Director, VISN-16 MD Lead for Advanced Liver Disease, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Ragesh Thandassery

  5. Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 5001 El Paso Drive, El Paso, TX, 79905, USA

    Mahesh Gajendran

  6. Department of Gastroenterology, University of Toledo, 3000 Arlington Ave, Mail Stop 1150, Toledo, OH, 43614, USA

    Mohammad Aziz

  7. Director of General and Advanced Endoscopy, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Benjamin Tharian

  8. Program Director- Advanced Endoscopy Fellowship, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Sumant Inamdar

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Contributions

Kemmian D. Johnson, Abhilash Perisetti, Hemant Goyal helped in conception and design. Kemmian D. Johnson, Abhilash Perisetti, Hemant Goyal contributed to literature search. Kemmian D. Johnson helped in first draft. All authors were involved in critical revision and editing and final approval.

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Correspondence to Hemant Goyal.

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Johnson, K.D., Perisetti, A., Goyal, H. et al. Liver Biopsy in Pregnancy: Two Case Reports and Review of the Literature. Dig Dis Sci 66, 4090–4098 (2021). https://doi.org/10.1007/s10620-020-06786-2

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