Outpatient Liver Biopsy: How Safe Is It? (1993)

Editorials15 January 1993Outpatient Liver Biopsy: How Safe Is It?Guadalupe Garcia-Tsao, MD and James L. Boyer, MDGuadalupe Garcia-Tsao, MDYale University School of Medicine, New Haven, CT 06510. and James L. Boyer, MDYale University School of Medicine, New Haven, CT 06510.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-118-2-199301150-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Percutaneous liver biopsy is being done more frequently as a result of major changes in the therapy of liver diseases.The ease and safety of outpatient, "blind" liver biopsy has been well established. Complication rates have ranged from 0.9% to 3.7%; most complications have become manifest within the first 3 hours after biopsy, and none has resulted in death. Nevertheless, differing guidelines may affect relative degrees of safety in different Centers. A review of reported series suggests that the Menghini technique may be the preferred first choice, with the Tru-Cut technique reserved for patients in whom an adequate sample cannot be ...References1. von Frerichs FT. Uber den Diabetes. Berlin: Hirschwald; 1884. Google Scholar2. Huard P, May JM, Joyeux B. La ponction biopsie du foie et son utilite dans le diagnostic des affections hepatiques. Annales d'Anatomie Pathologique. 1935; 12:1118-24. Google Scholar3. Baron E. Aspiration for removal of biopsy material from the liver. Arch Intern Med. 1939; 63:276-89. Google Scholar4. Menghini G. One-second needle biopsy of the liver. Gastroenterology. 1958; 35:190-99. Google Scholar5. Terry R. Risks of needle biopsy of the liver. Br Med J. 1952; 1: 1102-05. Google Scholar6. Thaler H. Uber Vorteil und Risiko der Leberbiopsiemethode nach Menghini. Wien Klin Wochenschr. 1964; 76:533-8. Google Scholar7. Lindner H. Grenzen und Gefahren der perkutanen Leberbiopsie mit der Menghini-Nadel. Erfahrungen bei 80 000 Leberbiopsien. (Limitations and hazards of percutaneous liver biopsy with the Menghini needle. Experiences with 80,000 liver biopsies.) Dtsch Med Wochenschr. 1967; 39:1751-7. Google Scholar8. Knauer CM. Percutaneous biopsy of the liver as a procedure for outpatients. Gastroenterology. 1978; 74:101-2. Google Scholar9. Sherlock S, Dick R, Van Leeuwen DJ. Liver biopsy today. The Royal Free Hospital experience. J Hepatol. 1984; 1:75-85. Google Scholar10. Piccinino F, Sagnelli E, Pasquale G, Giusti G. Complications following percutaneous liver biopsy. A multicentre retrospective study on 68,276 biopsies. J Hepatol. 1986; 2:165-73. Google Scholar11. Frank H, Leodolter I. Prakitsche Erfahrungen mit der ambulanten Leberbiopsie. Wien Klin Wochenschr. 1966; 78:756-68. Google Scholar12. Rosson RR, Corral J, Jaski T. Outpatient liver biopsy. JAMA. 1972; 222:364. Google Scholar13. Ali MR, Clarke AC, Nicholson GI. Liver biopsy—an outpatient procedure. N Z Med J. 1978; 88:237-8. Google Scholar14. Perrault J, McGill DB, Ott BJ, Taylor WF. Liver biopsy: complications in 1000 inpatients and outpatients. Gastroenterology. 1978; 74:103-6. Google Scholar15. Westaby D, MacDougall BR, Williams R. Liver biopsy as a day-case procedure: selection and complications in 200 consecutive patients. Br Med J. 1980; 281:1331-2. Google Scholar16. Wright RA. Outpatient liver biopsy: one man's experience. South Med J. 1991; 84:889-90. Google Scholar17. Janes CH, Lindor KD. Outcome of patients admitted with complications after outpatient liver biopsies. Ann Intern Med. 1993; 118: 96-98. Google Scholar18. Jacobs WH, Goldberg SB. Statement on outpatient percutaneous liver biopsy. Dig Dis Sci. 1989; 3:322-23. Google Scholar19. Bateson MC, Hopwood D, Duguid HL, Bouchier IA. A comparative trial of liver biopsy needles. J Clin Pathol. 1980; 33:131-3. Google Scholar20. Judmaier G, Kathrein H. Ultraschallunterstutze perkutane Leber 'blind'-Punktion (Ultrasound-assisted percutaneous blind puncture of the liver.). Ultraschall Med. 1983; 4:81-4. Google Scholar21. Greiner L, Franken FH. Die sonographisch assitierte Leberbiopsie—Ablosung der blinden Leberpunktion? (Sonographically assisted liver biopsy—replacement for blind needle biopsy?) Dtsch Med Wochenschr. 1983; 108:368-72. Google Scholar22. Sugano S, Sumino Y, Hatori T, Mizugami H, Kawafune T, Abei T. Incidence of ultrasound-detected hematomas due to Tru-Cut needle liver biopsy. Dig Dis Sci. 1991; 36:1229-33. Google Scholar Author, Article, and Disclosure InformationAffiliations: Yale University School of Medicine, New Haven, CT 06510.Corresponding Author: James L. Boyer, MD, Department of Medicine and Liver Center, Digestive Diseases Section, Yale University School of Medicine, 333 Cedar Street, 1080 LMP, New Haven, CT 06510-8056. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byTransvenous Pressure Measurements and Liver BiopsyA Novel Non-invasive Method for Predicting Liver Fibrosis by Quantifying the Hepatic Vein WaveformThe Role of EUS in Liver BiopsyAnalysis of liver biopsies performed as outpatient and ınpatient, due to diffuse liver diseasesCurrent role of transient elastography in the management of chronic hepatitis B patientsDiagnostic Accuracy of Transient Elastography for Detecting Liver Fibrosis After Liver Trannsplantation: A Specific Cut-Off Value Is Really Needed?The LAW index as an accurate indicator of the initiation of antiviral treatment in patients with chronic hepatitis BBlind percutaneous liver biopsy in infants and children: Comparison of safety and efficacy of percussion technique and ultrasound assisted techniqueUsefulness of Ultrasonographic Scoring System in Diagnosis of Alcoholic CirrhosisQuantification of hepatic and visceral fat by CT and MR imaging: relevance to the obesity epidemic, metabolic syndrome and NAFLDUtility and limitations of APRI and FIB4 to predict staging in a cohort of nonselected outpatients with hepatitis CClinical Implications of the Serum Apelin Level on Portal Hypertension and Prognosis of Liver CirrhosisDiagnostic Performance of Real-Time Elastography in the Assessment of Advanced Fibrosis in Chronic Hepatitis CValidity of noninvasive markers of methotrexate-induced hepatotoxicity: a retrospective cohort studyA comparison of liver surface and hepatic vein wall ultrasound as markers for fibrosis or cirrhosis of the liverPrediction of fibrosis progression in chronic viral hepatitisThe use of DWI to assess spleen and liver quantitative ADC changes in the detection of liver fibrosis stages in chronic viral hepatitisScreening for Hepatitis C Virus Infection in Adults: A Systematic Review for the U.S. Preventive Services Task ForceRoger Chou, MD, Erika Barth Cottrell, PhD, MPP, Ngoc Wasson, MPH, Basmah Rahman, MPH, and Jeanne-Marie Guise, MD, MPHLiver Interventional ImagingUltrasonographic scoring system score versus liver stiffness measurement in prediction of cirrhosisReal-time elastography as a noninvasive technique for quantification of fibrosis in patients with chronic viral liver disease: Preliminary findingsARFI elastography in patients with chronic autoimmune liver diseases: A preliminary studyFindings of the UK National Audit Evaluating Image-guided or Image-assisted Liver Biopsy. Part I. Procedural Aspects, Diagnostic Adequacy, and AccuracyTraining the Gastroenterologist for NOTESSignificant clinical risks and the benefits of liver biopsies in Srinagarind Hospital, Khon Kaen University, Thailand: Lessons learned from the past to the presentEvaluation of transient elastography for fibrosis assessment compared with large biopsies in chronic hepatitis B and CPonction biopsie hépatique : techniques, incidents, accidentsQuantifying Liver Cirrhosis by Extracting Significant Features from MRI T2 ImageLiver Biopsy and LaparoscopyfMRI-Based Hierarchical SVM Model for the Classification and Grading of Liver FibrosisThe Safety of Same-Day Endoscopy and Percutaneous Liver BiopsyUse of the AST to platelet ratio index in HCV/HIV co-infected patientsNeedle-based confocal laser endomicroscopy to assess liver histology in vivoLiver Transplantation: Prevention and Treatment of RejectionHepatic Steatosis (Fatty Liver Disease) in Asymptomatic Adults Identified by Unenhanced Low-Dose CTRisk factors for NSF: A literature reviewFunctional magnetic resonance imaging monitoring of pathological changes in rodent livers during hyperoxia and hypercapniaHistologic Abnormalities are Common in Protocol Liver Allograft Biopsies From Patients With Normal Liver Function TestsReview article: gastrointestinal amyloidosis - clinical features, diagnosis and therapyPerforming a percutaneous liver biopsy in parenchymal liver diseasesRisk factors associated with nonalcoholic fatty liver disease and its relationship with the hepatic histological changesMethotrexate: prescribing and monitoring practices among the consultant membership of the British Association of DermatologistsDiagnosis of Cirrhosis by Spiral Computed TomographyPercutaneous Liver Biopsy Is Safe in Chronic Hepatitis C Patients With End-Stage Renal DiseaseNoninvasive Diagnosis of Hepatic Fibrosis in Patients With Chronic Hepatitis C by Splenic Doppler Impedance IndexMethotrexate for Psoriatic ArthritisNoninvasive serum markers in the diagnosis of structural liver damage in chronic hepatitis C virus infectionHemostasis in chronic liver diseaseSafety and Efficacy of Fluoroscopic versus Ultrasound Guidance for Core Liver Biopsies in Potential Living Related Liver Transplant Donors: Preliminary ResultsAspartate aminotransferase to platelet ratio index for fibrosis evaluation in chronic viral hepatitisThe Combined Elevation of Tumor Markers CA 19-9 and CA 125 in Liver Disease Patients Is Highly Specific for Severe Liver FibrosisComputed tomography guided needle biopsy: experience from 1,300 proceduresDelayed hemorrhage from hepatic artery after ultrasound-guided percutaneous liver biopsy: A case reportLiver BiopsySerum laminin, type IV collagen and hyaluronan as fibrosis markers in non-alcoholic fatty liver diseaseProspective Randomized Trial of Post-liver Biopsy Recovery PositionsReplacement of routine liver biopsy by procollagen III aminopeptide for monitoring patients with psoriasis receiving long-term methotrexate: a multicentre audit and health economic analysisA Canadian multicenter retrospective study evaluating transjugular liver biopsy in patients with congenital bleeding disorders and hepatitis C: Is it safe and useful?Punción biopsia hepática ambulatoria guiada por ultrasonografía: descripción técnica y complicacionesGallbladder polyp as a manifestation of hemobilia caused by arterial-portal fistula after percutaneous liver biopsy: A case reportLiver biopsy in patients with inherited disorders of coagulation and chronic hepatitis CScreening for Hepatitis C Virus Infection: A Review of the Evidence for the U.S. Preventive Services Task ForceRoger Chou, MD, Elizabeth C. Clark, MD, MPH, and Mark Helfand, MD, MPHRecombinant activated factor VII (rFVIIa) as a hemostatic agent in liver disease: A break from convention in need of controlled trialsMethotrexate and psoriasis in the era of new biologic agentsUpodate on chronic hepatitis CPrimary (AL) Hepatic AmyloidosisIs There A Role for Liver Biopsy in Primary Sclerosing Cholangitis?Liver biopsy and laparoscopyHepatitis crónica por virus C en pacientes coinfectados por el virus de la inmunodeficiencia humanaControlling Pain in Liver Biopsy, or "We Will Probably Need to Repeat the Biopsy in a Year or Two to Assess the Response"Liver BiopsyLiver biopsy: When, how, by whom, and where?Tratamiento de la infección crónica por el virus de la hepatitis C en los pacientes coinfectados por el virus de la inmunodeficiencia humana: de lo que sabemos a lo que ignoramosValoración de la utilidad y eficacia de un hospital de día en un servicio de patología digestivaThe Role of the Interventional Radiologist: Transjugular ProceduresDelayed fatal hemorrhage from pseudoaneurysm of the hepatic artery after percutaneous liver biopsyPractices of Liver Biopsy in France: Results of a Prospective Nationwide SurveyDiagnostic approach to patients with cholestatic jaundiceHISTOPATHOLOGY OF ALCOHOLIC LIVER DISEASECLINICAL ISSUES IN THE MANAGEMENT OF ALCOHOLIC LIVER DISEASEAlcoholic liver disease: proposed recommendations for the American College of GastroenterologyNoninvasive prediction of fibrosis in C282Y homozygous hemochromatosisClinicopathology conferences: Inflammation-induced cholestasisCost-effectiveness of ultrasound-guided liver biopsyWhat is the criterion for differentiating chronic hepatitis from compensated cirrhosis? A prospective study comparing ultrasonography and percutaneous liver biopsyMETHOTREXATE HEPATOTOXICITYMethotrexateCurrent Thoughts on the Use of Methotrexate in Patients with PsoriasisLiver biopsyOutpatient Liver Biopsy in Children: A Medical Position Statement of the North American Society for Pediatric Gastroenterology and NutritionInvestigation of hepatitis C in haemophilia including liver biopsyIs day case liver biopsy underutilised?Quantitative liver testing with MEG-X: More optimism?Outpatient liver biopsy using ultrasound guidance and the Biopty™ gun is safe and cost effectiveAn ultrasound scoring system for the diagnosis of liver disease in cystic fibrosisLiver biopsy bleeding time: An unpredictable eventMethotrexate for Rheumatoid ArthritisLiver biopsy and laparoscopyLiver biopsy and laparoscopy 15 January 1993Volume 118, Issue 2Page: 150-153KeywordsBiopsyHemorrhageInpatientsLiverLiver diseasesLiver transplantationOutpatientsPrimary sclerosing cholangitisSafetyUltrasound imaging Issue Published: 15 January 1993 Copyright & PermissionsCopyright © 1993 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...