Over 2 decades experiences shows that ultrasound-guided liver biopsy is the procedure of choice

Liver biopsy is a widely used tool in the investigation of liver diseases. It is invasive and has a mortality risk ranging between 0.01% and 0.17%. A liver biopsy should therefore only be performed in patients who would potentially benefit from it.

Over the last two decades, we have seen a staggering increase in patients with type 2 diabetes mellitus and obesity. These are likely to reflect changes in our socio-economic status and life-styles. Non-alcoholic steatohepatitis, the liver manifestation of the metabolic syndrome, is now one of the leading causes of chronic liver diseases and an indication for liver transplantation.

A review was therefore undertaken in a typical district general hospital in the UK, looking at the indications, findings and complications of liver biopsies. The changes in liver biopsy practice and the utility of a liver biopsy were explored. All liver biopsies between 1986 and 2006 were analysed. Clinical data was available for 88 patients who underwent 95 liver biopsies.

Between 1986 and 1996, 95% of all biopsies were performed ¡®blind¡¯ (USS-guided in 5%). 33% of biopsies were performed for patients with primary biliary cirrhosis. Between 1996 and 2006, 18% of all biopsies were performed ¡®blind¡¯ (USS-guided in 78%; other routes in 4%). The majority of liver biopsies (>40%) were performed in patients with raised liver tests and hepatitis C infection. The reduced number of liver biopsies for primary biliary cirrhosis is the result of the development of reliable marker for confirming diagnosis and predicting outcome. Investigators also noted an increasing number of patients diagnosed with non-alcoholic fatty liver disease (17% vs. 26%).

In the analyses, investigators found that a liver biopsy was useful in confirming diagnoses in over 90% of patients with abnormal liver function tests but non-specific liver screening investigations. It was also found to be helpful in ¡®staging¡¯ diseases, allowing clinicians to detect the development of cirrhosis (scarring) and to place patients on appropriate treatment or surveillance protocols.

Pain was the most common complication after a liver biopsy (5.2% of biopsies). There was no biopsy-related mortality, but there was a trend towards greater technical failures and complications with the ¡®blind¡¯ liver biopsy technique. These complications included pneumothorax and bleeding around the liver capsule.

This study confirms the safety and utility of the liver biopsy, even in small district hospitals; ultrasound-guided liver biopsy is the procedure of choice.