SinglePass Kronos electrocautery device for closure after percutaneous medical liver biopsy: Five case reports

Table 1 Liver biopsy methodologies

Method	Indication	Advantages	Limitations	Risks	Relative bleeding risk
Palpation/percussion-guided	Diffuse disease	Simple, low-cost	Less accurate, poor sample yield	Collateral damage, need for repeat biopsy	+++
Image-marked/blind	Focal lesions, abnormal anatomy	More accurate	Additional equipment required, inconsistent yield	Bleeding, collateral damage	++
Real-time image-guided	Focal lesions, abnormal anatomy	More accurate, more procedural flexibility	Additional equipment and training required	Bleeding, collateral damage	++
Plugged, real-time image-guided	Mild coagulopathy, higher bleeding risk	Lower bleeding risk, allows biopsy in higher-risk patients	Procedure complexity	Pain, extended observation	+
Trans-jugular	Coagulopathy, ascites, portal hypertension	Allows biopsy in high-risk patients	Smaller/inconsistent samples, vascular access required	Vascular damage	+
Laparoscopic/surgical	Direct visualization required or contraindication to percutaneous methods	Direct access, multiple sites can be sampled, complete samples	Significantly invasive, longer recovery time	Infection, pain, collateral damage	+++

Symbol “+” indicates elevated value.

Table 2 Case series summary

Case	Age (years)/gender (M/F)	Clinical presentation	Biopsy indication	Anti-platelet/anti-coagulant	Lab and imaging findings	Diagnosis/management	Post-biopsy bleeding?	Post-biopsy complications
1	21/F	Obese, type 2 diabetes, NASH, fibrosis	Fibrosis staging	Neither	AST +, ALT + TBIL +	Weight loss program and semaglutide	No	None
2	71/M	Hepatitis B e-antigen negative chronic hepatitis, HCC	Clinical trial inclusion	Neither	AST +	Immunotherapy via clinical trial, withdrew due to HCC progression	No	None
3	64/F	Abnormal LFT, Hashimoto’s, + autoimmune serologies, no hepatotoxic meds	Rule out autoimmune hepatitis	Neither	AST +, ALT +	No intervention planned, counseled to avoid supplements, periodic lab surveillance	No	None
4	67/F	Obese, metabolic syndrome, unexplained iron deficiency, mild steatosis	Fibrosis staging and rule out iron overload	Rivaroxaban	TBIL +, MRI showed mild steatosis and possible iron overload	Negative significant fibrosis and iron overload, follow-up MRI negative, periodic surveillance planned	No	None
5	47/M	Substance and alcohol abuse, 3-year sobriety, jaundice post- cholecystectomy, increasing pruritus	Diagnostic assistance	Neither	INR +, AST +, ATL +, ALP +, TBIL +, imaging negative for stone, biliary or ductal obstruction	Medical management initially with ursodeoxycholic acid pending specific plan from hepatology	No	None

M: Male; F: Female; NASH: Non-alcoholic steatohepatitis; HCC: Hepatocellular carcinoma; LFT: Liver function test; AST: Aspartate aminotransferase; ATL: Alanine aminotransferase; TBIL: Total bilirubin; MRI: Magnetic resonance imaging; INR: International normalized ratio; ALP: Alkaline phosphatase.