Liver assessment and biopsy in patients with marked coagulopathy: value of mini-laparoscopy and control of bleeding

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Am. Coll. of Gastroenterology

Volume 98 , Issue 4 , Pages 893-900

Liver assessment and biopsy in patients with marked coagulopathy: value of

mini-laparoscopy and control of bleeding *

Ulrike Denzer M.D. a * , Ilka Helmreich-Becker M.D. a , R. Galle M.D.

a and Ansgar W. Lohse M.D. a

Received: 2/17/2002. Accepted: 8/21/2002.

Abstract

Objectives

Evaluation of liver disease in patients with a high risk of postbiopsy

bleeding presents a diagnostic challenge. Mini-laparoscopy offers the

possibility of coagulation of biopsy site and the additional advantage of

macroscopic liver assessment. We wished to assess the value and safety of

mini-laparoscopy with guided biopsy as a diagnostic approach in patients in

whom percutaneous liver biopsy is considered contraindicated because of a

marked coagulopathy.

Methods

We investigated 61 consecutive patients with marked coagulopathy (prolonged

international normalized ratio > 1.5, thrombocytopenia < 50/nl, or both; von

Willebrand's disease/hemophilia). Diagnostic mini-laparoscopy with visually

guided liver biopsy was undertaken for the evaluation of liver disease.

Biopsy sites were coagulated prophylactically (n = 4) or therapeutically (n

= 52). Safety, diagnostic yield, and therapeutic consequences were assessed.

Results

Macroscopic assessment of the liver was possible in 60/61 high-risk patients

and was considered diagnostic in 1/61. In 58 of the remaining 60 patients,

liver biopsy was technically feasible. There was no persistent postbiopsy

bleeding. One patient with fulminant hepatic failure had self-limiting

bleeding from the abdominal wall. Ninety-seven percent of the biopsies were

of adequate size for diagnostic histological evaluation.

Conclusions

Mini-laparoscopy with guided liver biopsy allows reliable and safe

evaluation of liver disease in patients with severe coagulopathy.

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Dr. Helmreich-Becker's present address is: Gastroentological Practice,

Dotzheimerstr. 14, D-65185 Wiesbaden, Germany.Affiliations:

a First Department of Medicine, Johannes Gutenberg-University, Mainz,

Germany.

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[Guest guest]

Am. Coll. of Gastroenterology

Volume 98 , Issue 4 , Pages 893-900

Liver assessment and biopsy in patients with marked coagulopathy: value of

mini-laparoscopy and control of bleeding *

Ulrike Denzer M.D. a * , Ilka Helmreich-Becker M.D. a , R. Galle M.D.

a and Ansgar W. Lohse M.D. a

Received: 2/17/2002. Accepted: 8/21/2002.

Abstract

Objectives

Evaluation of liver disease in patients with a high risk of postbiopsy

bleeding presents a diagnostic challenge. Mini-laparoscopy offers the

possibility of coagulation of biopsy site and the additional advantage of

macroscopic liver assessment. We wished to assess the value and safety of

mini-laparoscopy with guided biopsy as a diagnostic approach in patients in

whom percutaneous liver biopsy is considered contraindicated because of a

marked coagulopathy.

Methods

We investigated 61 consecutive patients with marked coagulopathy (prolonged

international normalized ratio > 1.5, thrombocytopenia < 50/nl, or both; von

Willebrand's disease/hemophilia). Diagnostic mini-laparoscopy with visually

guided liver biopsy was undertaken for the evaluation of liver disease.

Biopsy sites were coagulated prophylactically (n = 4) or therapeutically (n

= 52). Safety, diagnostic yield, and therapeutic consequences were assessed.

Results

Macroscopic assessment of the liver was possible in 60/61 high-risk patients

and was considered diagnostic in 1/61. In 58 of the remaining 60 patients,

liver biopsy was technically feasible. There was no persistent postbiopsy

bleeding. One patient with fulminant hepatic failure had self-limiting

bleeding from the abdominal wall. Ninety-seven percent of the biopsies were

of adequate size for diagnostic histological evaluation.

Conclusions

Mini-laparoscopy with guided liver biopsy allows reliable and safe

evaluation of liver disease in patients with severe coagulopathy.

----------------------------------------------------------------------------

--

Dr. Helmreich-Becker's present address is: Gastroentological Practice,

Dotzheimerstr. 14, D-65185 Wiesbaden, Germany.Affiliations:

a First Department of Medicine, Johannes Gutenberg-University, Mainz,

Germany.

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