Outpatient Liver Biopsy: How Safe Is It?

Editorials15 January 1993Outpatient Liver Biopsy: How Safe Is It?Guadalupe Garcia-Tsao, MD and James L. Boyer, MDGuadalupe Garcia-Tsao, MDYale University School of Medicine, New Haven, CT 06510. and James L. Boyer, MDYale University School of Medicine, New Haven, CT 06510.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-118-2-199301150-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Percutaneous liver biopsy is being done more frequently as a result of major changes in the therapy of liver diseases.The ease and safety of outpatient, "blind" liver biopsy has been well established. Complication rates have ranged from 0.9% to 3.7%; most complications have become manifest within the first 3 hours after biopsy, and none has resulted in death. Nevertheless, differing guidelines may affect relative degrees of safety in different Centers. A review of reported series suggests that the Menghini technique may be the preferred first choice, with the Tru-Cut technique reserved for patients in whom an adequate sample cannot be ...References1. von Frerichs FT. Uber den Diabetes. Berlin: Hirschwald; 1884. Google Scholar2. Huard P, May JM, Joyeux B. La ponction biopsie du foie et son utilite dans le diagnostic des affections hepatiques. Annales d'Anatomie Pathologique. 1935; 12:1118-24. Google Scholar3. Baron E. Aspiration for removal of biopsy material from the liver. Arch Intern Med. 1939; 63:276-89. Google Scholar4. Menghini G. One-second needle biopsy of the liver. Gastroenterology. 1958; 35:190-99. Google Scholar5. Terry R. Risks of needle biopsy of the liver. Br Med J. 1952; 1: 1102-05. Google Scholar6. Thaler H. Uber Vorteil und Risiko der Leberbiopsiemethode nach Menghini. Wien Klin Wochenschr. 1964; 76:533-8. Google Scholar7. Lindner H. Grenzen und Gefahren der perkutanen Leberbiopsie mit der Menghini-Nadel. Erfahrungen bei 80 000 Leberbiopsien. (Limitations and hazards of percutaneous liver biopsy with the Menghini needle. Experiences with 80,000 liver biopsies.) Dtsch Med Wochenschr. 1967; 39:1751-7. Google Scholar8. Knauer CM. Percutaneous biopsy of the liver as a procedure for outpatients. Gastroenterology. 1978; 74:101-2. Google Scholar9. Sherlock S, Dick R, Van Leeuwen DJ. Liver biopsy today. The Royal Free Hospital experience. J Hepatol. 1984; 1:75-85. Google Scholar10. Piccinino F, Sagnelli E, Pasquale G, Giusti G. Complications following percutaneous liver biopsy. A multicentre retrospective study on 68,276 biopsies. J Hepatol. 1986; 2:165-73. Google Scholar11. Frank H, Leodolter I. Prakitsche Erfahrungen mit der ambulanten Leberbiopsie. Wien Klin Wochenschr. 1966; 78:756-68. Google Scholar12. Rosson RR, Corral J, Jaski T. Outpatient liver biopsy. JAMA. 1972; 222:364. Google Scholar13. Ali MR, Clarke AC, Nicholson GI. Liver biopsy—an outpatient procedure. N Z Med J. 1978; 88:237-8. Google Scholar14. Perrault J, McGill DB, Ott BJ, Taylor WF. Liver biopsy: complications in 1000 inpatients and outpatients. Gastroenterology. 1978; 74:103-6. Google Scholar15. Westaby D, MacDougall BR, Williams R. Liver biopsy as a day-case procedure: selection and complications in 200 consecutive patients. Br Med J. 1980; 281:1331-2. Google Scholar16. Wright RA. Outpatient liver biopsy: one man's experience. South Med J. 1991; 84:889-90. Google Scholar17. Janes CH, Lindor KD. Outcome of patients admitted with complications after outpatient liver biopsies. Ann Intern Med. 1993; 118: 96-98. Google Scholar18. Jacobs WH, Goldberg SB. Statement on outpatient percutaneous liver biopsy. Dig Dis Sci. 1989; 3:322-23. Google Scholar19. Bateson MC, Hopwood D, Duguid HL, Bouchier IA. A comparative trial of liver biopsy needles. J Clin Pathol. 1980; 33:131-3. Google Scholar20. Judmaier G, Kathrein H. Ultraschallunterstutze perkutane Leber 'blind'-Punktion (Ultrasound-assisted percutaneous blind puncture of the liver.). Ultraschall Med. 1983; 4:81-4. Google Scholar21. Greiner L, Franken FH. Die sonographisch assitierte Leberbiopsie—Ablosung der blinden Leberpunktion? (Sonographically assisted liver biopsy—replacement for blind needle biopsy?) Dtsch Med Wochenschr. 1983; 108:368-72. Google Scholar22. Sugano S, Sumino Y, Hatori T, Mizugami H, Kawafune T, Abei T. Incidence of ultrasound-detected hematomas due to Tru-Cut needle liver biopsy. Dig Dis Sci. 1991; 36:1229-33. Google Scholar Author, Article, and Disclosure InformationAffiliations: Yale University School of Medicine, New Haven, CT 06510.Corresponding Author: James L. Boyer, MD, Department of Medicine and Liver Center, Digestive Diseases Section, Yale University School of Medicine, 333 Cedar Street, 1080 LMP, New Haven, CT 06510-8056. 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