Controversies in Liver Biopsy: Who, Where, When, How, Why?

[Guest guest]

Current Gastroenterology Reports

Volume 6 Issue 1

Controversies in Liver Biopsy: Who, Where, When, How, Why?

Lawrence S Friedman MD

Department of Medicine, 2014 Washington Street, Newton-Wellesley Hospital,

Newton, MA, 02462, USA

Current Gastroenterology Reports 2004, 6:30-36 (published 1 February 2004)

Abstract

Liver biopsy continues to have a central role in the evaluation of patients

with suspected liver disease. The procedure is often indicated to evaluate

otherwise unexplained liver biochemical test abnormalities, but the precise

degree of serum aminotransferase elevations that should prompt a liver

biopsy is controversial, as is the need for liver biopsy in all patients

with suspected nonalcoholic fatty liver disease and chronic hepatitis C.

Standard liver biopsy is contraindicated in patients with severe

coagulopathy and ascites, although the degree of coagulopathy that

contraindicates a liver biopsy is controversial. A transjugular approach is

an alternative in patients with coagulopathy or ascites. Controversy

surrounds all the technical aspects of liver biopsy, particularly the choice

of needle (cutting vs suction) and the use of ultrasound to mark or guide

the biopsy site. Bleeding is the major complication of liver biopsy, with a

risk of 0.3%; cutting needles are more likely to cause hemorrhage than are

suction needles. Traditionally, liver biopsy has been the province of the

hepatologist gastroenterologist. However, an increasing number of liver

biopsies are performed by radiologists. The implications of this trend with

respect to patient outcome, safety, and training of fellows is unclear.

[Guest guest]

Current Gastroenterology Reports

Volume 6 Issue 1

Controversies in Liver Biopsy: Who, Where, When, How, Why?

Lawrence S Friedman MD

Department of Medicine, 2014 Washington Street, Newton-Wellesley Hospital,

Newton, MA, 02462, USA

Current Gastroenterology Reports 2004, 6:30-36 (published 1 February 2004)

Abstract

Liver biopsy continues to have a central role in the evaluation of patients

with suspected liver disease. The procedure is often indicated to evaluate

otherwise unexplained liver biochemical test abnormalities, but the precise

degree of serum aminotransferase elevations that should prompt a liver

biopsy is controversial, as is the need for liver biopsy in all patients

with suspected nonalcoholic fatty liver disease and chronic hepatitis C.

Standard liver biopsy is contraindicated in patients with severe

coagulopathy and ascites, although the degree of coagulopathy that

contraindicates a liver biopsy is controversial. A transjugular approach is

an alternative in patients with coagulopathy or ascites. Controversy

surrounds all the technical aspects of liver biopsy, particularly the choice

of needle (cutting vs suction) and the use of ultrasound to mark or guide

the biopsy site. Bleeding is the major complication of liver biopsy, with a

risk of 0.3%; cutting needles are more likely to cause hemorrhage than are

suction needles. Traditionally, liver biopsy has been the province of the

hepatologist gastroenterologist. However, an increasing number of liver

biopsies are performed by radiologists. The implications of this trend with

respect to patient outcome, safety, and training of fellows is unclear.

[Guest guest]

Current Gastroenterology Reports

Volume 6 Issue 1

Controversies in Liver Biopsy: Who, Where, When, How, Why?

Lawrence S Friedman MD

Department of Medicine, 2014 Washington Street, Newton-Wellesley Hospital,

Newton, MA, 02462, USA

Current Gastroenterology Reports 2004, 6:30-36 (published 1 February 2004)

Abstract

Liver biopsy continues to have a central role in the evaluation of patients

with suspected liver disease. The procedure is often indicated to evaluate

otherwise unexplained liver biochemical test abnormalities, but the precise

degree of serum aminotransferase elevations that should prompt a liver

biopsy is controversial, as is the need for liver biopsy in all patients

with suspected nonalcoholic fatty liver disease and chronic hepatitis C.

Standard liver biopsy is contraindicated in patients with severe

coagulopathy and ascites, although the degree of coagulopathy that

contraindicates a liver biopsy is controversial. A transjugular approach is

an alternative in patients with coagulopathy or ascites. Controversy

surrounds all the technical aspects of liver biopsy, particularly the choice

of needle (cutting vs suction) and the use of ultrasound to mark or guide

the biopsy site. Bleeding is the major complication of liver biopsy, with a

risk of 0.3%; cutting needles are more likely to cause hemorrhage than are

suction needles. Traditionally, liver biopsy has been the province of the

hepatologist gastroenterologist. However, an increasing number of liver

biopsies are performed by radiologists. The implications of this trend with

respect to patient outcome, safety, and training of fellows is unclear.

[Guest guest]

Current Gastroenterology Reports

Volume 6 Issue 1

Controversies in Liver Biopsy: Who, Where, When, How, Why?

Lawrence S Friedman MD

Department of Medicine, 2014 Washington Street, Newton-Wellesley Hospital,

Newton, MA, 02462, USA

Current Gastroenterology Reports 2004, 6:30-36 (published 1 February 2004)

Abstract

Liver biopsy continues to have a central role in the evaluation of patients

with suspected liver disease. The procedure is often indicated to evaluate

otherwise unexplained liver biochemical test abnormalities, but the precise

degree of serum aminotransferase elevations that should prompt a liver

biopsy is controversial, as is the need for liver biopsy in all patients

with suspected nonalcoholic fatty liver disease and chronic hepatitis C.

Standard liver biopsy is contraindicated in patients with severe

coagulopathy and ascites, although the degree of coagulopathy that

contraindicates a liver biopsy is controversial. A transjugular approach is

an alternative in patients with coagulopathy or ascites. Controversy

surrounds all the technical aspects of liver biopsy, particularly the choice

of needle (cutting vs suction) and the use of ultrasound to mark or guide

the biopsy site. Bleeding is the major complication of liver biopsy, with a

risk of 0.3%; cutting needles are more likely to cause hemorrhage than are

suction needles. Traditionally, liver biopsy has been the province of the

hepatologist gastroenterologist. However, an increasing number of liver

biopsies are performed by radiologists. The implications of this trend with

respect to patient outcome, safety, and training of fellows is unclear.