Indications, methods, and outcomes of percutaneous liver biopsy in England and Wales: an audit by the British Society of Gastroenterology and the Royal College of Physicians of London (original) (raw)
Related papers
Liver biopsy: complications and risk factors
World Journal of Gastroenterology, 2000
retrospectively. RESULTS There were 484 percutaneous liver biopsies performed. The total complication rate was 6.4%, of which 4.5% were due to major bleeding; the death rate was 1.6%. The important risk factors correlated with bleeding complications and deaths were a platelet count of 70×10 9 /L or less, a prolonged prothrombin time of >3 seconds over control, or a prolonged activated partial thromboplastin time of >10 seconds over control. Although physician inexperience was not statistically significantly associated with bleeding complications and deaths, there was a reduction of death rate from 2.2% in 1987-1993 to 0% in 1993-1996. This reduction is thought to result from both increased experience of senior staff and increased supervision of residents. CONCLUSIONS Screening of platelet count, prothrombin time, and activated partial thromboplastin time should be done and need to be corrected in case of abnormality before liver biopsy. Percutaneous liver biopsy should be performed or supervised by an expert in gastrointestinal diseases, especially in high risk cases.
Practice and complications of liver biopsy
Digestive Diseases and Sciences, 1993
Studies on the complication rate of liver biopsy have hitherto been conducted in referral hospital centers. They are therefore not representative for general practice where liver biopsy is performed by specialists and nonspecialists. In a postal nationwide survey, we approached all gastroenterologists and hospital internists to assess the complication rate and practice (setting, needle type, use of ultrasonography) of percutaneous liver biopsy performed in 1989 in Switzerland for diffuse liver disease. Two hundred eighty questionnaires were mailed and 252 were returned (response rate 90. 0%) 165 respondents (65.5%) performed 3501 biopsies while 87 respondents (34. 5%) did not practice liver biopsy; 67. 7% of biopsies were executed blindly and 32.3% were guided. Eight nonfatal and three fatal complications occurred. Hemorrhage was the most frequent complication (five cases) and was responsible for all three fatal outcomes. The overall complication rate was 0.31%, being distinctly lower in the group of gastroenterologists (0.11%) as compared to the group of internists (0. 55%; P = O. 031). The complication rate was 1.68% in the group of internists performing fewer than 12 biopsies pc:'year, while there was no complication in the group of internists performing more than 50 biopsies per year (P = O. 036). Complications were not related to the needle diameter or to the absence of ultrasonography before biopsy. In conclusion, this representative survey in Switzerland shows that the complication rate of liver biopsy is mainly related to the experience and training of the operator.
Decreasing liver biopsy complications
Annals of internal medicine
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Is day case liver biopsy underutilised?
Gut, 1995
Day case liver biopsies are rarely performed nationally but have been routine practice in selected patients in our hospital since 1989. We have audited our experience of this procedure to compare its safety, and efficacy with inpatient biopsy and assess patient acceptability. Audit data were collected retrospectively on liver biopsies performed at a teaching hospital over 42 months. Acceptability of day case biopsy was assessed by a questionnaire. A total of 182 of 546 biopsies were day cases (33%). The specimen quality was similar in both groups. The overall complication rate did not significantly differ between the two groups (277% day case v 3.3% inpatients). There were no deaths or episodes of haemorrhage in the day cases but one patient developed a pneumothorax. Some 91% of those who had a day case biopsy were satisfied with the procedure. Day case liver biopsy is safe, effective, and acceptable in selected patients.
Fine-needle liver biopsy in patients with severely impaired coagulation
Liver, 1993
Severe coagulation defects, as reflected by platelet count and prothrombin time, have always been considered a contraindication to needle biopsy of the liver, but there are very limited data on the actual rate of bleeding in patients with such severe alterations and none whatsoever on the bleeding risk associated with newer, fine-gauge needles that produce less trauma to the liver tissue. In addition, there has never been any evidence that platelet count and/or prothrombin time are the most sensitive indices of bleeding risk. This retrospective study of 85 patients, with platelet counts less than 50000/mm3 and/or prothrombin times less than 50% of controls, subjected to ultrasound-guided fine-needle liver punctures for diagnostic or therapeutic (percutaneous ethanol injection) purposes showed no bleeding episodes after any of the 229 punctures performed. No type of replacement therapy was administered to correct clotting defects prior to the procedure. Correct pathologic diagnoses were obtained in 8 1.2% of all patients. Ultrasound-guided fine needle puncture appears to be safer than currently believed in patients with severe clotting defects and deserves further evaluation as an alternative to surgical procedures to diagnose and treat liver lesions, even when severe coagulation impairment is present. Percutaneous needle biopsy of the liver under local anesthesia is a simple bedside procedure that provides tissue diagnosis of liver disease without subjecting the patient to the greater risk of general anesthesia and laparotomy to obtain an open surgical biopsy. Percutaneous punctures can also be used to deliver ethanol injections to treat isolated malignant lesions of the hepatic parenchyma. These procedures are not, however, without risk and have generally been considered to be contraindicated in patients who are uncooperative or who cannot control movements of the diaphragm (e.g. those with severe, recurrent coughs) (l), patients with heart failure and consequent liver congestion (2) and those with severe bleeding disorders (1, 3); patients with ascites (3), cholangitis (3), amyloidosis (4), liver neoplasms (5-7), severe anemia (8), sepsis (8) or dilated intrahepatic bile ducts (9) have also traditionally been considered poor risks for needle biopsies of the liver.
Diagnostic and Interventional Radiology, 2019
P ercutaneous tissue biopsy is a mainstay of diagnostic and interventional radiology, providing a minimally invasive method for diagnosing malignant and benign disease commonly in an outpatient setting (1-3). In particular, percutaneous liver biopsies constitute a large portion of all biopsies and are being performed with an ever-increasing rate (4). The use of imaging guidance has improved biopsy accuracy and decreased the rate of overall complications (1). Despite these advances, complications do occur and could result in significant morbidity and mortality for the patient (1, 5, 6). Post-biopsy hemorrhage (PBH) is the main source of mortality following liver biopsy and occurs in up to 10.9% of cases (7). The majority of PBH occur within the first 2-4 hours following the procedure (8), necessitating the need for close monitoring of the patient during this period. Several risk factors have been identified that contribute to the likelihood of bleeding complications following liver biopsy. These risk factors are categorized as either patient-related, operator-related, or procedure-related and range from coagulation status, PURPOSE Percutaneous tissue biopsy is a mainstay of diagnostic and interventional radiology, providing a minimally invasive method for diagnosing malignant and benign disease. The purpose of this review was to collect and summarize the best available evidence regarding the risk factors associated with bleeding complications in image-guided liver biopsy. METHODS A literature review was performed, searching Medline, EMBASE, CINAHL, the Cochrane Library, the National Institute for Health and Care Excellence (NICE) and Canadian Agency for Drugs and Technology in Health (CADTH) databases for any studies evaluating bleeding complications in image-guided liver biopsy. A total of 68 articles, published between January 1994 and April 2015, were reviewed in full, with 34 ultimately eligible for inclusion in the review. RESULTS Bleeding of any kind occurred in up to 10.9% of image-guided liver biopsies, with major bleeding episodes ranging from 0.1% to 4.6% and minor bleeding events occurring in up to 10.9% of biopsies. The overall rate of bleeding was, however, found to be less than 2%. Several risk factors (patient, operator, and procedure-related) were identified as potentially indicative of an increased risk of post-biopsy bleeding. Patient-related risk factors included patient age (>50 years or <2 years), inpatient status (8/12 vs. 4/12, P < 0.001), comorbidities and/or concurrent diagnoses and coagulation status (rate of bleeding was 3.3% for international normalized ratio [INR] 1.2-1.5 vs. 7.1% for INR >1.5, P < 0.001). There was no consensus on impact of operator experience (>200 biopsies/year vs. <50/year) on post-biopsy bleeding rate. Procedure-related risk factors included needle size (cutting biopsy vs. fine needle aspiration, P < 0.001) and the presence of a patent track on post-biopsy ultrasound (P < 0.001). Lastly there was no difference found between targeted vs. nontargeted biopsies and number of needle passes. CONCLUSION Reported rate of post-biopsy bleeding ranges between 0% and 10.9%, although the vast majority of studies reported bleeding rates under 2%. Several patient, operator, and procedure-related risk factors are associated with a higher risk of bleeding following liver biopsy.
Variation between centers in technique and guidelines for liver biopsy
Liver, 1996
Hospitals have few published guidelines to follow when performing a liver biopsy. In 1992, we began revising our protocol in an effort to institute new guidelines for our teaching hospitals. To assess the current practice of liver biopsy, we sent 500 multilingual questionnaires to international academic centers, and 85 U.S. centers were surveyed by telephone. The survey assessed: 1) patient preparation, 2) technical aspects of the biopsy, and 3) post-procedural care. One hundred and eighty international centers and 85 U.S. centers responded (total = 265). We found a wide variation in the practice of this surgical procedure at both national and international centers. Many Asian centers (73%) performed a bleeding time prior to liver biopsy. This practice was seen in only 36% of the U.S. centers. Most centers preferred platelet counts of 50,000/mm3 and above. The aspiration needle was more widely used in the U.S. (74%) and in many international centers, but Asian centers (61%) preferred a cutting needle. Thirty percent of Japanese centers performed more than 50% of their liver biopsies laparoscopically. Few laparoscopies were done at other centers. While about a quarter of the reported U.S., European, Asian, and South American centers observed patients for 4-6 hours after a biopsy, the majority of centers observed patients 10 hours or more. In addition to the wide variation seen, this survey provided us with an academic view of the contemporary practice of liver biopsy and an insight into how to redefine our present guidelines.
The role of ultrasonography and automatic-needle biopsy in outpatient percutaneous liver biopsy
Hepatology, 1996
Percutaneous liver biopsies are frequently performed opsy is low, but discomfort is common and complications to establish the diagnosis, assess prognosis, and monirequire hospitalization in approximately 4% of patients. tor therapy for various liver diseases. Although the rate The optimal method of performing these biopsies is unof serious complications is õ1%, the rate of complicaknown. The goal of our study was to determine whether tions requiring hospitalization is around 4% and failure the use of ultrasonography in the biopsy room immedito obtain liver tissue occurs in approximately 2% of ately prior to or during the procedure would lessen the patients. 1-4 It has been assumed by many that ultrarisk of complications and to compare the safety and effisound enhances the safety of liver biopsy, but few concacy in obtaining tissue by use of a Trucut needle versus trolled trials of ultrasound versus blinded biopsies in an automatic biopsy needle. Between 1992 and 1994, 836 the absence of suspected masses have been published. 5 patients were entered into a randomized study (489 in Rochester, MN; 347 in Barcelona, Spain). Patients were If ultrasound prevented complications of liver biopsy randomized immediately prior to liver biopsy into four while at the same time increasing the yield of diagnosgroups: Trucut needle, or automatic biopsy needle, and tic liver tissue, the additional expense might be justiwith or without ultrasonography. Fisher's Exact Test fied. and a logistic regression model were also used to assess The complication rates with a cutting-type needle the effect of needle and ultrasonography on the odds for (Trucut or Silverman) and an aspiration-type needle complications. The four biopsy groups were well-(Jamshidi or Menghini) still are debated, 1,3,6 but probamatched at entry with respect to age, sex, underlying bly are about the same. However, the yield of liver liver disease, hemoglobin, prothrombin time, and platetissue from fibrotic livers is thought to be higher with let count. The use of ultrasound was associated with a the cutting-type needle. 7 An automatic biopsy needle decreased rate of hospitalization for pain, hypotension, or bleeding (2 vs. 9, P õ .05). No difference in safety was (Microvasive, Boston, MA) has been developed that thefound between the two types of needles. The number of oretically possesses the advantages of a cutting-type passes needed to obtain specimens was similar for all needle without the need for manual manipulation. 8 four groups. The average length of the specimen was Formal studies regarding the adequacy of the tissue slightly greater with ultrasonographic-guided biopsies obtained with this automatic biopsy needle have not (1.7 mm vs. 1.6 mm, P õ .05) and with biopsies obtained been performed. using the automatic biopsy needle when compared with Late complications occurring days to weeks after the Trucut needle (1.7 mm vs. 1.5 mm, P õ .05), but this liver biopsy have not been prospectively evaluated. Perdid not seem to be clinically important. The addition of sonal experience as well as reports from the literature ultrasonography reduces complications in patients unindicate that this may be a problem that has not been dergoing percutaneous liver biopsy. The type of needle appears to offer little difference in safety or yield of diag-adequately addressed. 9,10 In this study, we sought to nostic tissue. The use of ultrasonography for guidance determine whether the use of ultrasonography at the of percutaneous liver biopsy will lead to a lower rate of time of biopsy would improve the safety or diagnostic complications. The value of this benefit must be weighed yield, whether an automatic biopsy needle held any against the added cost of ultrasonographic guidance. advantage over the traditional Trucut needle, and
Liver biopsy: Analysis of results of two specialist teams
World journal of gastrointestinal pathophysiology, 2014
To analyze the safety and the adequacy of a sample of liver biopsies (LB) obtained by gastroenterologist (G) and interventional radiologist (IR) teams. Medical records of consecutive patients evaluated at our GI unit from 01/01/2004 to 31/12/2010 for whom LB was considered necessary to diagnose and/or stage liver disease, both in the setting of day hospital and regular admission (RA) care, were retrieved and the data entered in a database. Patients were divided into two groups: one undergoing an ultrasonography (US)-assisted procedure by the G team and one undergoing US-guided biopsy by the IR team. For the first group, an intercostal approach (US-assisted) and a Menghini modified type needle 16 G (length 90 mm) were used. The IR team used a subcostal approach (US-guided) and a semiautomatic modified Menghini type needle 18 G (length 150 mm). All the biopsies were evaluated for appropriateness according to the current guidelines. The number of portal tracts present in each biopsy wa...