Ultrasound-guided liver biopsy

Abstract

Liver biopsy for chronic liver diseases is mandatory for the assessment of grading and staging of the disease and for a proper therapeutic decision. Several types of biopsy needles are available: suction needles (Menghini type) and cutting needles (Tru-cut or Vim-Silverman needle). The most important question regarding the percutaneous liver biopsy that should be addressed is: blind or echoguided techniques? The answer depends on the skills of the gastroenterologist. However, it is still debatable whether ultrasound-guided liver biopsy has advantage over the blind one or not. The complications of liver biopsy seem to be related to the type of the technique, blind or echoguided, respectively. Other two aspects are important to be discussed: 1) the decrease in the incidence of complications in relationship with the experience of the physician who performs the biopsy, and 2) the correlation between the rate of complications and the type of the needles used for biopsy. In our Department of Gastroenterology, we performed 1200 liver biopsies during the last 10 years, all echoguided, usually under sedation with Midazolam (3–5 mg i.v.), using Menghini type needles (1.4–1.6 mm diameter), under hospitalization conditions. We had only one major complication (1/1200 biopsies), haemoperitoneum (0.083%). In conclusion, echoguided liver biopsy is a safe method for the diagnosis of chronic diffuse liver diseases (cost-effectiveness in comparison with blind biopsy), and the rate of complications seems to be related to the experience of the physician and the type of the needle (Menghini type needle is safer). Liver biopsy for chronic liver diseases is mandatory for the assessment of grading and staging of the disease and for a proper therapeutic decision. Several types of biopsy needles are available: suction needles (Menghini type) and cutting needles (Tru-cut or Vim-Silverman needle). The most important question regarding the percutaneous liver biopsy that should be addressed is: blind or echoguided techniques? The answer depends on the skills of the gastroenterologist. However, it is still debatable whether ultrasound-guided liver biopsy has advantage over the blind one or not. The complications of liver biopsy seem to be related to the type of the technique, blind or echoguided, respectively. Other two aspects are important to be discussed: 1) the decrease in the incidence of complications in relationship with the experience of the physician who performs the biopsy, and 2) the correlation between the rate of complications and the type of the needles used for biopsy. In our Department of Gastroenterology, we performed 1200 liver biopsies during the last 10 years, all echoguided, usually under sedation with Midazolam (3–5 mg i.v.), using Menghini type needles (1.4–1.6 mm diameter), under hospitalization conditions. We had only one major complication (1/1200 biopsies), haemoperitoneum (0.083%). In conclusion, echoguided liver biopsy is a safe method for the diagnosis of chronic diffuse liver diseases (cost-effectiveness in comparison with blind biopsy), and the rate of complications seems to be related to the experience of the physician and the type of the needle (Menghini type needle is safer).