Liver biopsy in modern clinical practice: indications, methods and safety

Despite the widespread availability of serological tests and radiological imaging modalities, liver biopsy remains a commonly performed procedure employed in the diagnosis, prognostic assessment, and determination of further patient management strategies. The principal indications for biopsy include focal hepatic lesions of undetermined etiology, diffuse liver diseases, unexplained elevation of hepatic enzymes, and suspected transplant organ rejection; the main contraindications are thrombocytopenia, hypocoagulation, and ascites. Owing to technological advances and the availability of multiple biopsy techniques, all established contraindications have become relative in nature, while complication and mortality rates remain low. Traditionally, liver biopsy was performed using the blind percutaneous technique or under ultrasound guidance. Alternative methods now exist that allow adequate tissue sampling with a significantly reduced complication profile. Transluminal endoscopic procedures (natural orifice transluminal endoscopic surgery, NOTES) and robotic technologies represent promising avenues for further development; however, their widespread integration into clinical practice requires additional investigation. This literature review addresses the indications and contraindications for the procedure, the types of liver biopsy, their associated complications, and the principal strategies for enhancing procedural safety.