The role of gender on clearance of hepatitis C virus: a different story in an area endemic for hepatitis B and C

setting that provides close observation for 1 hour after a biopsy. However, we keep a conservative and different view on the sufficiency and safety of 1 hour observation time after a liver biopsy. We have performed a total of 3806 liver biopsies using 18-gauge needle on 2980 patients (males 1817, females 1163, mean age was 41.3 years, range 17-72 years), performed in a medical centre and in a core regional hospital in southern Taiwan from Jan 1996 through Sep 2006. Our outpatient biopsy was assigned to a 6-hour observation time. The reasons for the liver biopsy studies on these patients, were either a result of chronic viral hepatitis or a surveillance of abnormal liver function tests. There was no clinical evidence of cirrhosis diagnosed by high-resolution ultrasound before a biopsy. Patients who have thrombocytopenia or the presence of oesophageal varices, ascites, splenomegaly, signs of portal hypertension, or encephalopathy by other imaging studies as well as bleeding tendencies, were excluded. These procedures have been done by six well-trained, board certified hepatologists. Apart from minor complications such as pain, nausea, and vomiting, a total of 12 patients (0.32%) suffered from haemorrhagic complications 4 to 12 hours after the biopsy (table 1). Our results were comparable with those of Beddy et al in terms of major complications and mortality. Although there was no death at follow up of one week, four patients did experienced hypovolemic shock. In one patient, haemobilia, presenting with insidious onset of tarry stool, obstructive jaundice, and hypovolemic shock, developed 24 hours after the biopsy. The total in-hospital days therefore were extended and ranged from 1 to 7 days. In rare occasions haemorrhagic complications such as haemoperitoneum, haemothorax, and haemobilia did occur with potential risk of morbidity and mortality after the procedure. Noteworthy is that those with poor performance such as liver cirrhosis and bleeding tendency were excluded from our study. Major complications occurred in four patients after the regular observation time. This does, indicate a possible need of a longer time of observation. Therefore, our study with a 6-hour observation time basis concluded that although ultrasound-guided liver biopsy is generally a safe procedure, major haemorrhage complications may occur more than one hour after liver biopsy. A longer time of observation may be more suitable with this potential risky procedure.