Minilaparoscopy in the Diagnosis of Cirrhosis: Superiority in Patients with Child-Pugh A and Macronodular Disease

Helmreich-Becker, I; Schirmacher, Peter; Denzer, Ulrike W.; Hensel, Anke; Büschenfelde, K H Meyer zum; Lohse, Ansgar W.

doi:10.1055/s-2003-36419

Cited by 41 publications

(22 citation statements)

References 12 publications

(22 reference statements)

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“…While decompensated liver cirrhosis is easy to detect clinically, the diagnosis of compensated stages of ACLD may be more challenging. The combination of macroscopic and microscopic assessments of the liver has previously been shown to be superior to the histological evaluation alone for the detection of fibrous changes [11,14,19] , most likely due to the sampling error generated by just one liver biopsy [4] . Accordingly, laparoscopy revealed a significant number of patients in our care suffering from severe fibrosis or cirrhosis, but understaged by histology.…”

Section: Discussionmentioning

confidence: 99%

“…After a successful biopsy, the insufflated CO 2 was aspirated and the sedation terminated. The macroscopically evaluated stage of fibrosis was defined as reported [11] . For a better macroscopic discrimination between beginning and severe fibrosis, a macroscopic graduation was defined as presented in table 1 and figure 1.…”

Section: Liver Fibrosis/cirrhosis Evaluation By Mini-laparoscopymentioning

confidence: 99%

“…The laparoscopically performed assessment of the liver surface reliably complements the histological evaluation of advanced liver disease in the clinically compensated state and detects up to 37% more patients with cirrhosis [11] compared with the histological assessment alone. The prognostic benefit resulting from this additional information has not been evaluated yet.…”

Section: Introductionmentioning

confidence: 99%

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High Prognostic Value of Mini-Laparoscopy for Advanced Liver Disease-Related Complications in Patients with HCV Infection

Zizer

Backhus²,

Bohl³

et al. 2016

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Background/Aim: The assessment of advanced chronic liver disease (ACLD) is a prerequisite for therapy and surveillance in patients with chronic hepatitis C infection. Mini-laparoscopy-assisted liver biopsies facilitate both histological and macroscopical evaluation of liver fibrosis. This study is aimed at investigating the prognostic significance of the laparoscopic assessment for the cumulative incidence of ACLD-related events. Patients and Methods: We performed a single center, retrospective analysis of 94 patients with either macroscopically or/and microscopically assessed advanced fibrosis/cirrhosis caused by chronic hepatitis C infection. The patients' data, the respective laboratory results, and follow-up period were evaluated in the outpatient clinic. Results: The group with both macro- and microscopic diagnosed ACLD showed a significantly higher number of decompensating events (n = 7) compared with the other 2 groups (n = 0 in the group with only histological and n = 1 in the group with only laparoscopic diagnosis of advanced liver disease). The results were not affected by the successful treatment of the hepatitis C virus. In the Cox-regression analysis, the spleen size (>120 mm) was significantly associated with the incidence of ACLD-related events. Conclusions: Assessment of ACLD in chronic hepatitis C by mini-laparoscopy-assisted liver biopsies may facilitate the selection of patients with a poor prognosis, irrespective of achieving a sustained virological response following treatment. Follow-up of these patients should be intensified to treat decompensation early.

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Section: Discussionmentioning

confidence: 99%

Section: Liver Fibrosis/cirrhosis Evaluation By Mini-laparoscopymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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High Prognostic Value of Mini-Laparoscopy for Advanced Liver Disease-Related Complications in Patients with HCV Infection

Zizer

Backhus²,

Bohl³

et al. 2016

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“…In another interesting study [23], authors correlated macroscopic diagnosis of cirrhosis (caused by a number of different aetiologies) with microscopic findings and blinded pathologists to the findings of the surgeons. Authors found that visual diagnosis of cirrhosis at the time of laparoscopy was superior to targeted liver biopsy for diagnosis of liver cirrhosis and increased the sensitivity of diagnosis by more than 30 % compared to laparoscopically targeted biopsy alone [23]. Authors concluded histological understaging was far commoner than macroscopic (surgical) understaging, which only happened in 2 % of the patients.…”

Section: Early Diagnosis Of Cirrhosismentioning

confidence: 99%

Routine Liver Biopsy During Bariatric Surgery: an Analysis of Evidence Base

et al. 2015

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Non-alcoholic fatty liver disease and non-alcoholic steato-hepatitis are common in patients undergoing bariatric surgery. Non-alcoholic steato-hepatitis can progress to cirrhosis of the liver and hepatocellular carcinoma. Non-invasive methods of diagnosing non-alcoholic steato-hepatitis are not as accurate as liver biopsy, and bariatric surgery presents a unique opportunity to carry out a simultaneous liver biopsy. Routine liver biopsy can help early and accurate diagnosis of obesity-associated liver conditions. This has led some surgeons to argue for routine liver biopsy at the time of bariatric surgery. However, most bariatric surgeons remain unconvinced and liver biopsy is currently not routine practice with bariatric surgery. This review examines published scientific literature to ascertain the usefulness of routine liver biopsy at the time of bariatric surgery.

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“…Allerdings findet sich bei etwa 1/3 der AIH-Patienten bei Erstdiagnose bereits eine komplette Leberzirrhose. Eine sonographisch assistierte Leberpunktion unterschätzt häufig das Ausmaß der Zirrhose, besser ist hier eine minilaparoskopisch entnommene Leberprobe, die bereits einen makroskopischen Eindruck erlaubt und eine leichte Punktion beider Leberlappen ermöglicht [9]. Mit Ausnahme der fulminanten Verläu-fe kann eine Lebertransplantation bei nahezu allen nicht-zirrhotischen Patienten und den meisten Patienten mit früher Leberzirrhose vermieden werden.…”

Section: Prognoseunclassified

Autoimmune liver diseases

et al. 2009

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Autoimmune hepatitis (AIH) can occur in all age groups. AIH affects women more commonly than men (3:1). Clinical presentation may be an acute hepatitis up to fulminant liver failure, but can also be asymptomatic. AIH is characterized by lymphoplasmacellular infiltrates on liver biopsy, elevated liver enzymes in serum and the absence of active viral markers. Patients characteristically present with hypergammaglobulinemia, elevated serum levels of IgG and autoantibodies. Corticosteroids are the drug of choice for induction of remission, azathioprine the drug of choice for maintenance of remission. Rapid response to immunosuppressive treatment supports the diagnosis and leads to a good long-term prognosis.Primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) are immune mediated diseases affecting bile ducts. While PBC has a slow progression to cirrhosis and complications mostly will be limited to complications of cirrhosis, PSC additionally carries a high risk of developing cholangiocellular carcinoma. The treatment of choice in PBC and PSC is oral ursodeoxycholic acid which may slow progression of liver disease and may ameliorate lab findings.

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Minilaparoscopy in the Diagnosis of Cirrhosis: Superiority in Patients with Child-Pugh A and Macronodular Disease

Cited by 41 publications

References 12 publications

High Prognostic Value of Mini-Laparoscopy for Advanced Liver Disease-Related Complications in Patients with HCV Infection

High Prognostic Value of Mini-Laparoscopy for Advanced Liver Disease-Related Complications in Patients with HCV Infection

Routine Liver Biopsy During Bariatric Surgery: an Analysis of Evidence Base

Autoimmune liver diseases

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