Safety and Efficacy Performance of Coaxial 18G vs 20G Needles for Pediatric Percutaneous Liver Biopsy: A Retrospective Cohort Study

Percutaneous liver biopsy is a cornerstone in the diagnostic and therapeutic management of pediatric liver diseases, yet data on the optimal needle gauge for coaxial techniques in children remain scarce. Smaller-gauge needles may enhance safety but could potentially compromise diagnostic yield. Objectives: To compare the safety, diagnostic adequacy, and clinical impact of ultrasound-guided percutaneous liver biopsies performed with semi-automated coaxial 18-G versus 20-G needles in pediatric patients. Patients and Methods: This retrospective cohort study included all consecutive patients aged ≤19 years who underwent percutaneous liver biopsy at a tertiary university-affiliated medical center between 2006 and 2012. Demographics, biopsy technique (needle gauge, number of cores, tract embolization), diagnostic yield, and procedure-related complications were analyzed. Technical adequacy was defined by diagnostic pathology, ≥7 portal tracts, or direct impact on patient management. Complications were classified according to the Society of Interventional Radiology guidelines. Results: A total of 320 biopsies were performed in 260 patients (44.6% females, mean age 7.4±6 years). Indications included post-liver transplantation (28.4%) and unexplained liver enzyme elevation (22.5%). Biopsies were performed with 18G (46.3%) or 20G (53.7%) needles, obtaining a median of three cores. Technical success was achieved in 100% of cases, with biopsy results influencing clinical management in 39.7%. The overall complication rate was 5.3% (3.4% minor, 1.9% major), with no procedure-related mortality. Complication rates did not differ significantly between 18G and 20G needles (p=0.41). Conclusions: Ultrasound-guided coaxial percutaneous liver biopsy in children demonstrates high diagnostic yield and low complication rates. The use of a 20G needle is as safe and effective as an 18G needle, supporting its routine use across all pediatric age groups.