Incidence of Complications from Percutaneous Biopsy in Chronic Liver Disease: A Systematic Review and Meta-Analysis

Abstract

Background Approaches to liver biopsy have changed over the past decade in patients with chronic liver disease. Aims We conducted a systematic review and meta-analysis on the incidence of all complications and technical failure associated with percutaneous liver biopsy. Methods We systematically searched PubMed and the Cochrane Library for cohort studies reporting on complications resulting from liver biopsy published between 2010 and 2020. Studies on participants of any age and sex, who underwent any percutaneous biopsy for non-focal liver disease, were selected. All events except mild pain, minor hematoma, vasovagal episodes, fever and fistula were defined as major complications. Random-effect model meta-analyses with and without covariates were performed, to examine the effect of publication year, patient characteristics, outcome collection, and biopsy type on incidences. Results We identified 30 studies reporting on complications resulting from percutaneous liver biopsy procedures (n = 64,356). Incidence of major complications was 2.44% (95% CI 0.85, 6.75), with mortality at 0.01% (95% CI 0.00, 0.11), hospitalization at 0.65% (95% CI 0.38, 1.11), major bleeding at 0.48% (95% CI 0.22, 1.06), and moderate/severe pain at 0.34% (95% CI 0.08, 1.37). Minor complications at 9.53% (95% CI 3.68, 22.5) were mainly pain at 12.9% (95% CI 5.34, 27.9). Technical failure was high at 0.91% (95% CI 0.27, 3.00). Decreasing patient age significantly increased incidence of hospitalization and major bleeding (P < 0.0001). Hospitalization incidence also significantly increased with disease severity. Conclusions Incidence of major (2.4%) and minor (9.5%) complications, and technical failure (0.91%) in percutaneous liver biopsies continues.

A Diagnostic Test Meta‐Analysis Evaluating Imaging‐Based and Blood Biomarker–Based Assessment Tools for Fibrosis After Liver Transplantation

“…( 6 ) Furthermore, liver biopsies are invasive and not without complications. ( 7 ) These limitations have led to the development of noninvasive tests (NITs) in the assessment of liver fibrosis. The NITs that are commonly used in clinical practice are fibrosis models constructed using readily available clinical information such as the Fibrosis‐4 Index (FIB‐4) and vibration‐controlled transient elastography (VCTE).…”

LiverMultiScan as an alternative to liver biopsy to monitor autoimmune hepatitis in the National Health Service in England: an economic evaluation

“…Liver biopsy can be associated with high care costs particularly due to the possibility of postprocedure complications arising in approximately 32.5% of patients, which include pain (24.1%), major bleeding (3.5%), minor bleeding (2.7%), transient hypotension (1.0%) and a mortality rate of as high as 1.2%. 4 29 30 In addition in-hospital monitoring is required for all patients for at least 6–8 hours with frequent vitals and blood pressure measurements. Moreover, as up to 5% of patients may require readmission for biopsy-linked complications, including bleeding and pain, liver biopsy is an unattractive and costly way to assess for a disease flares or remission.…”

“…Moreover, as up to 5% of patients may require readmission for biopsy-linked complications, including bleeding and pain, liver biopsy is an unattractive and costly way to assess for a disease flares or remission. 4 30 Percutaneous liver biopsy should only be performed when the benefits of knowing the histology outweigh the risks to the patient. In contrast to this, the proposed care pathway for monitoring AIH patients using mpMR scanning as a monitoring tool eliminates the risk of such complications, and therefore the associated costs, hospitalisation and mortality rates.…”

Repeatability and reproducibility of deep-learning-based liver volume and Couinaud segment volume measurement tool

“…There is a lack of clear evidence guiding the modulation of safe lower FLR limits for an individual patient, often due to the failure to detect parenchymal liver disease prior to surgery. Interpreting liver function tests can be complex [17] and biopsy-derived pathology scores are associated with risk of haemorrhage and prone to sampling bias [18].…”