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Abstract

Percutaneous biopsy is considered one of the most important diagnostic tools to evaluate diffuse liver diseases. The introduction and widespread diffusion of ultrasounds in medical practice has improved percutaneous bioptic technique, while reducing postoperative complications. Although ultrasonography has become almost ubiquitous in prebiopsy investigation, only one third of biopsies are performed under ultrasound control. Moreover, the one-day procedure, reported in several studies to be safe and cost effective, accounted for only 4% of biopsies done. We report our experience of 142 percutaneous US-guided biopsies performed on 140 patients affected by chronic diffuse liver disease over a four-year period. Liver biopsies were performed under US guidance at the patient's bed using an anterior subcostal route. We evaluated postoperative pain, modifications of blood pressure and red cell count, hospital stay, morbidity and mortality rates, and adequacy of specimens for histologic examination. There was no operative mortality. As for major complications, one case of hemobilia occurred. As for minor complications, two cases of persistent postoperative pain required analgesic therapy. Patients were discharged the day following the procedure in all cases but two, who were discharged on the third and fifth postoperative days. Liver specimens were suitable for histologic diagnosis in all but one case, in which there were no portal spaces. According to our experience, we believe that hepatic biopsy guided by ultrasonography could replace blinded biopsy in the diagnosis of diffuse liver disease. The procedure is suitable to be performed safely on an outpatient basis.

Percutaneous Liver Biopsies Guided with Ultrasonography: A Case Series

“…Nevertheless, it has major disadvantages; it is an invasive method with a risk of complication and there are difficulties in evaluating the biopsy specimen. Biopsy of the liver under US guidance increases the diagnostic yield by obtaining sufficient liver specimen, subsequently increasing the probability of definitive pathological diagnosis (1, 2, 4, 5, 10, 13). In our series, the overall rates of complications were only 3% and most of them (80.6%) were minor and self-limited.…”

“…In the literature, the US-guided percutaneous liver biopsy reduced post-biopsy pain significantly as well as the need of analgesics. Literature determined that the post-biopsy pain rates are between 5% and 50% (2, 4, 5, 8). Our study showed a lower pain and complication rate compared to those reported in the literature.…”

“…Although liver biopsy is an easy procedure for hospitalized patients and outpatients, some complications or technical failures may occur in up to 5% of the patients, including pain requiring hospital admissions, bleeding requiring transfusion, bleeding requiring surgery, pneumothorax, failure to obtain tissue and obtaining other tissues (2, 4, 5, 8). However, attempts to increase safety and decrease complications of liver biopsy should be made (2, 5).…”

“…However, attempts to increase safety and decrease complications of liver biopsy should be made (2, 5). There is also a statistically significant decrease in the complication rates of liver biopsies when performed under ultrasound guidance (4, 6, 11, 12).…”

Delayed hepatic rupture post ultrasound-guided percutaneous liver biopsy

“…[ 1 ] The use of Imaging guidance for liver biopsy markedly reduces the incidence of procedure-related complications. [ 2 , 3 ] Ultrasound, because of its real-time imaging and relative low cost, becomes first choice of modality and the most widely used method. However, due to the invasive nature of this procedure, complications are sometimes inevitable.…”