• Information
  1. Indications (Table 1 in [1])
  2. Procedure
  3. Percutaneous Liver BIopsy
  4. Laparoscopic Liver Biopsy (Table 4 in [1])
• Resources

A. Indications (Table 1 in [1])

1. Diagnosing, grading and/or staging of chronic hepatitis
   1. Alcoholic liver disease
   2. Steatohepatitis
   3. Autoimmune hepatitis
2. Grading and staging of chronic viral hepatitis
   1. Hepatitis B virus ± Delta virus
   2. Hepatitis C virus
3. Hemochromatosis
   1. Diagnosis (confirmation)
   2. Quantitation of iron levels
4. Wilson's Disease
   1. Diagnosis
   2. Quantitative estimation of copper levels
5. Evaluation of chronic cholestatic liver diseases
   1. Primary biliary cirrhosis
   2. Sclerosing cholangitis
6. Evaluation of abnormal liver tests with no clear etiology
7. Evaluation of drug effects (such as methotrexate for treatment of psoriasis)
8. Diagnosis of liver mass
9. Liver Transplantation
   1. Evaluation of transplanted liver
   2. Evaluation of donor liver prior to transplantation
10. Fever of unknown origin evaluation (tissue culture)

B. Procedure

1. Several methods for obtaining liver tissue
   1. Percutaneous (see below)
   2. Transjugular
   3. Laparoscopic
   4. Fine needle (guided by ultrasound or computed tomography)
2. Size of biopsy typically 1-3cm in length and 1.2-2mm in diagmeter
3. For diffuse liver disease, at least 1.5cm length of tissue is required
4. Most common complication is bleeding from biopsy site
5. Indications for transjugular liver biopsy
   1. Severe coagulopathy
   2. Mass ascites
   3. Suspected vascular tumor or peliosis hepatis
   4. Need for ancillary vascular procedure such as TIPSS or venography
   5. Failure of percutaneous liver biopsy

C. Percutaneous Liver BIopsy

1. Most common type performed
2. Suction, cutting, or spring loaded cutting needles are used
3. Ultrasound is usually used to guide the process
4. Performed in most cases as outpatient procedure
5. Absolute Contraindications (Table 2 in [1])
   1. Uncooperative patient
   2. History of unexplained bleeding
   3. Tendency to bleed: significantly elevated PT or bleeding time, platelets <50K/µL
   4. Use of nonsteroidal antiinflammatory drug within previous 7-10 days
   5. Blood for transfusion unavailable
   6. Suspected hemangioma or other vascular tumor
   7. Inability to identify appropriate site for biopsy by percussion or ultrasound
   8. Suspected echinococcal cysts in liver
6. Relative Contraindications
   1. Morbid obesity
   2. Ascites
   3. Hemophilia
   4. Infection in right pleural cavity or below right hemidiaphragm
7. Complications
   1. 60% occur within 2 hours and >95% within 24 hours
   2. Pain and hypotension are the most serious complications
   3. About 2% of patients require hospitalization after biopsy
   4. Significant intraperitoneal hemorrhage is very rare but most serious bleed
   5. Mortality after percutaneous biopsy is about 1:10,000

D. Laparoscopic Liver Biopsy (Table 4 in [1])

1. Indications
   1. Cancer staging
   2. Ascites of unclear cause
   3. Peritoneal infections
   4. Evaluation of an abdominal mass
   5. Unexplained hepatosplenomegaly (as in lymphoma, infection)
2. Absolute Contraindications
   1. Severe cardiopulmonary failure
   2. Intestinal obstruction
   3. Bacterial peritonitis
3. Relative Contraindications
   1. Uncooperative patient
   2. Severe coagulopathy
   3. Morbid obesity
   4. Large ventral hernia

Resources

MELD Score

References

1. Bravo AA, Sheth SG, Chopra S. 2001. NEJM. 344(7):495