The purpose of this study was to retrospectively evaluate the incidence of intraperitoneal bleeding and other major complications of transjugular liver biopsy (TJLB) and analyze their outcome and management.

The clinical files of 341 consecutive patients who had TJLB were retrospectively analyzed. There were 237 men and 104 women (mean age: 51.38±12.8 years; range: 17–89 years). All patients had TJLB because standard percutaneous transhepatic biopsy was contraindicated. Patients’ files were reviewed to search for major and minor procedure-related complications during or immediately after TJLB.

TJLBs were technically successful in 331/341 patients (97.07%; 95%CI: 94.67–98.58%). Major complications consisted exclusively of intraperitoneal bleeding due to liver capsule perforation and were observed in 2/341 patients (0.59%; 95%CI: 0.07–2.10%). They were treated using transcatheter arterial or venous embolization with a favorable outcome. The most frequent minor complications were abdominal pain (35/341; 10.26%; 95%CI: 7.25–13.99%) and supraventricular arrhythmia (15/341; 4.40%; 95%CI: 2.48–7.15%). No cases of inadvertent injury of the carotid artery were observed.

Major complications during TJLB are extremely rare and can be managed using arterial or venous embolization with a favorable outcome. Our results reinforce the general assumption that TJLB is a safe and well-tolerated technique.