Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology

Abstract

<jats:p>Liver biopsy is required when clinically important information about the diagnosis, prognosis or management of a patient cannot be obtained by safer means, or for research purposes. There are several approaches to liver biopsy but predominantly percutaneous or transvenous approaches are used. A wide choice of needles is available and the approach and type of needle used will depend on the clinical state of the patient and local expertise but, for non-lesional biopsies, a 16-gauge needle is recommended. Many patients with liver disease will have abnormal laboratory coagulation tests or receive anticoagulation or antiplatelet medication. A greater understanding of the changes in haemostasis in liver disease allows for a more rational, evidence-based approach to peri-biopsy management. Overall, liver biopsy is safe but there is a small morbidity and a very small mortality so patients must be fully counselled. The specimen must be of sufficient size for histopathological interpretation. Communication with the histopathologist, with access to relevant clinical information and the results of other investigations, is essential for the generation of a clinically useful report.</jats:p>

Hepatic Steatosis Predicts Higher Incidence of Recurrence in Colorectal Cancer Liver Metastasis Patients

“…Although the sensitivity of L/S ratio is not very high, it's still the widely used approach to diagnose hepatic steatosis, due to its non-invasive nature and easy access ( 26 ). Liver biopsy is the gold standard for hepatic steatosis, but it is invasive with a risk of complications and evaluates only a very small portion of the overall organ ( 27 ). It will cause sampling error because of heterogeneous development in chronic liver disease ( 28 ).…”

Administration of Antithrombotic Treatment Was a Risk Factor for Intraperitoneal Hemorrhage in Patients Undergoing Percutaneous Interventions for Liver Diseases.

“…There were 3 patients in whom liver biopsy was performed while administered aspirin and no hemorrhage was observed in all patients after liver biopsy. Regarding aspirin, as stated in the BSG guideline about liver biopsy published in 2020, if it cannot be discontinued for various reasons, it may be acceptable to perform under administration 17 . According to the guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment from the Japanese Gastroenterological Endoscopy Society, thromboembolic complications due to warfarin withdrawal in procedures occurred in 12 stroke of 1137 cases.…”

“…When patients discontinued antithrombotic therapies before interventions, three-point major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke) were not detected in these patients until discharge to home. Twenty-ve patients treated with combination therapy discontinued these drugs according to the AASLD guidelines for liver biopsy and guidelines on the use of liver biopsy from the BSG 17,21 , and there was no intraperitoneal hemorrhage after interventions in these patients. In conclusion, intraperitoneal hemorrhage occurred in only nine patients (0.88%), and these adverse events were not severe.…”

“…Usually, we performed interventions according to the guidelines for liver biopsy 17 . In these guidelines for liver biopsy, discontinuation of antithrombotic therapy is recommended for patients before interventions.…”

“…However, in many patients with chronic liver disease, there are inherently abnormalities in hematological parameters, with disturbances in both thrombolysis and coagulation. Usually, we performed interventions according to the guidelines for liver biopsy 17 . In these guidelines for liver biopsy, discontinuation of antithrombotic therapy is recommended for patients before interventions.…”