Abstract
BackgroundUltrasonographically guided punctures of the liver represent a decisive tool in the diagnosis of many diseases of the liver. Objective of the study was to determine the extent to which the complication rate for ultrasonographically guided punctures of the liver is affected by less comprehensively studied risk factors.MethodsA total of 2,229 liver biopsies were performed in 1,961 patients (55.5% males; 44.5% females). We recorded actual complications and assessed the following risk factors: needle gauge, puncture technique, examiner experience, coagulation status, puncture target (focal lesion versus parenchyma), lesion size, patient sex and age.Resultshe rate of complications stood at 1.2% (n = 27), of which 0.5% (n = 12) were major and 0.7% (n = 15) minor complications. A significant increase in complications involving bleeding was observed with larger-gauge needles compared with smaller-gauge needles and for cutting biopsy punctures compared with aspiration biopsies (Menghini technique). In the bivariate analysis complications were 2.7 times more frequent in procedures performed by experienced examiners compared with those with comparatively less experience. Lower values for Quick’s test and higher partial thromboplastin times were associated with a higher rate of bleeding. Neither the puncture target, lesion size or patient sex exerted any measurable influence on the puncture risk. Advanced patient age was associated with a higher rate of complications involving bleeding.ConclusionsOur study helps to establish the importance of potential and less comprehensively studied risk factors and may contribute to further reduction in complications rates in routine clinical practice.
Highlights
Guided punctures of the liver represent a decisive tool in the diagnosis of many diseases of the liver
Low rate of complications and brief post-procedure monitoring, these interventions can usually be performed on an ambulatory basis, which contributes to their cost-efficiency [2,5,6]
Many factors may influence the risk of complications and, to date, there is a paucity of quantitative data from studies with large patient collectives addressing certain risk factors
Summary
Guided punctures of the liver represent a decisive tool in the diagnosis of many diseases of the liver. Guided percutaneous liver biopsies are an important diagnostic and therapeutic option in routine clinical practice [1,2,3,4]. They are employed in the work-up of patients with suspected diffuse liver diseases, for treatment monitoring and staging of hepatitis, and for diagnostic clarification of hepatic lesions [1]. With their limited invasivity, low rate of complications and brief post-procedure monitoring, these interventions can usually be performed on an ambulatory basis, which contributes to their cost-efficiency [2,5,6]. The following potential risk factors were assessed in the present study: target of biopsy (focal lesion, parenchyma), lesion size, and patient’s sex and age
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