Near-fatal hemorrhagic shock after endoscopic ultrasound-guided liver biopsy
Bibliographic record
Abstract
Endoscopic ultrasound (EUS)-guided liver biopsy with a 19-gauge fine-needle aspiration (FNA) needle is safe and provides excellent diagnostic yield [ 1 ] [ 2 ] [ 3 ] [ 4 ]. Post-procedural bleeding is a well-known complication of liver biopsy [ 5 ]. Although it is reasonable to assume that similar complications may arise after EUS-guided liver biopsy, no complications of this nature have been reported thus far. We present a case of hemorrhagic shock after EUS-guided liver biopsy. A 60-year-old man with no medical history was hospitalized with painless jaundice and severe dehydration of 2 weeks’ duration. Liver tests showed cholestasis (bilirubin 859 μmol/L). The serum creatinine was 1165 μmol/L. Gallstones were noted on abdominal ultrasound, with no dilated ducts and no portal hypertension. EUS was performed to evaluate the cholestasis further. After biliary obstruction had been excluded, transgastric EUS-guided liver biopsy was performed with a standard 19-gauge needle (EchoTip; Cook Medical, Bloomington, Indiana, USA). Three passes were executed with a “wet-stylet” technique. The platelet count was 83 000/mm 3 , and the international normalized ratio (INR) was 1.2. The patient was discharged from the recovery unit 1 hour after the procedure. At 6 hours after the procedure, he was found unresponsive in his bed. Immediate resuscitation was performed. Laparotomy showed a massive hemoperitoneum with active bleeding from the liver. Five units of blood were transfused. The postoperative evolution was unremarkable. Liver histology found nonspecific cholestasis. The liver and renal function test results normalized 15 days after admission. In most institutions, the post-procedural recovery time for EUS is approximately 60 minutes. However, it is customary to keep patients under observation longer with bed rest for 2 to 4 hours after they undergo percutaneous liver biopsy [ 5 ]. Given the complication of bleeding reported here, we now monitor patients for 4 hours after EUS-guided liver biopsy – as is done according to protocols for percutaneous liver biopsy. In conclusion, EUS-guided liver biopsy can result in severe bleeding. Post-biopsy surveillance should be adjusted accordingly. Platelet dysfunction induced by renal failure may also have contributed to the bleeding and might be considered a relative contraindication to EUS-guided liver biopsy. Endoscopy_UCTN_Code_CPL_1AL_2AG
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".