Reduced Mortality Rates Following Elective Percutaneous Liver Biopsies

Division of Epidemiology and Public Health, Nottingham City Hospital, University of Nottingham, Nottingham, United Kingdom.
Gastroenterology (Impact Factor: 16.72). 10/2010; 139(4):1230-7. DOI: 10.1053/j.gastro.2010.06.015
Source: PubMed


Estimates of complication rates following elective percutaneous liver biopsy vary and might not accurately reflect current practice. We studied mortality and complication rates, by indication, in patients after they underwent liver biopsies.
We performed a study using hospital episode statistics collected by the National Health Service in England from 1998 to 2005 of elective percutaneous liver biopsies; data were linked with those from the Office for National Statistics to determine mortality rates. Using data from 61,187 people who underwent liver biopsies, all-cause mortality at 7 and 30 days after biopsy, 7-day mortality directly related to liver biopsy, and episodes of bleeding up to 7 days after biopsy were determined.
Overall all-cause mortality by 7 days after biopsy was 2 per 1000 biopsies (95% confidence interval, 1.8-2.5); this rate varied markedly by indication for biopsy, with rates as high as 12 per 1000 for patients investigated for cancer. Death within 7 days directly related to liver biopsy occurred, at most, every 1 in 10,000 biopsies in patients investigated for liver disease or abnormal liver function test results. Overall, 6 episodes of major bleeding occurred per 1000 biopsies.
All-cause mortality risk following elective percutaneous liver biopsy is approximately 0.2%, with a higher risk of major bleeding. Deaths directly related to liver biopsy occur approximately 1 in every 10,000 biopsies. This risk is substantially lower than that of previous reports, indicating that the safety of this procedure has improved.

59 Reads
  • Source
    • "Accurate assessment of the extent of liver fibrosis remains one of the most important factors determining the need for active treatment [2]. Although liver biopsy (LB) with subsequent histological analysis is still considered as a main tool for evaluation of presence and the extent of liver fibrosis, it is however, associated with numerous drawbacks such as patient discomfort, a risk for complications and patient morbidity and mortality, a substantial sample and interobserver variability while being highly dependent of the experience of pathologist interpreting the biopsy specimen [3] [4] [5] [6] [7] [8]. Additionally, several reports are suggesting that the accuracy of LB is suboptimal in differentiation of adjacent stages of liver fibrosis and that even cirrhosis may be missed [9] [10]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The use of commercially available noninvasive markers for chronic hepatitis B (CHB) related fibrosis is not widely available in developing countries so clinicians in those countries frequently use free alternatives. We aimed to create an optimized algorithm for selection of patients with the highest probability for presence/absence of significant liver fibrosis and cirrhosis based on the use of multiple free scores. We evaluated six free noninvasive markers for CHB related fibrosis against liver biopsy and selected the best thresholds for prediction/exclusion of significant fibrosis and cirrhosis in CHB patients. Algorithm based on four scores and their corresponding thresholds was created. The calculator based on developed algorithm can be found at We evaluated 211 patients in main group and 65 patients in external validation group. We selected four scores for creation of combination algorithm. The algorithm was able to classify 123/211 (58.3%) patients with a 93.5% accuracy of correct classification for prediction of presence/absence of significant fibrosis in main group. In validation group, the algorithm was able to classify 48/65 (73.8%) of patients with 93.8% (45/48) overall accuracy. When used to predict presence/absence of cirrhosis, the algorithm was able to correctly classify 181/211 (85.8%) and 59/65 (90.8%) of patients in main and validation group, respectively, with an overall accuracy of 97.8% and 98.3%, respectively. Developed algorithm based on routine laboratory tests is a usable, applicable and accurate tool for diagnosis of CHB related fibrosis and cirrhosis, suitable for resource-limited settings where more expensive modalities are unavailable. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
    European Journal of Internal Medicine 07/2015; 26(8). DOI:10.1016/j.ejim.2015.07.005 · 2.89 Impact Factor
  • Source
    • "In our department, it is routine following CB and ABM but not following FNAC. Our mortality rate of 0.0% corresponds with the very low rate of puncture-related mortality of 0.0-0.4% documented in the literature [2,13-15]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Ultrasonographically 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. Methods A 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. Results he 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. Conclusions Our 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.
    BMC Gastroenterology 12/2012; 12(1):173. DOI:10.1186/1471-230X-12-173 · 2.37 Impact Factor
  • Source
    • "Last but not least, liver biopsy is an invasive procedure with a small but significant risk of procedure-related morbidity (pain occurring in 20% and major complications such as intraperitoneal bleeding and hemobilia in 0.5%) [4], with a mortality rate of 0.009-0.12% [10]. Thus, liver biopsy can be poorly tolerated by patients, especially if it needs to be repeated. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The presence and degree of hepatic fibrosis is crucial in order to make therapeutic decisions and predict clinical outcomes. Currently, the place of liver biopsy as the standard of reference for assessing liver fibrosis has been challenged by the increasing awareness of a number of drawbacks related to its use (invasiveness, sampling error, inter-/intraobserver variability). In parallel with this, noninvasive assessment of liver fibrosis has experienced explosive growth in recent years and a wide spectrum of noninvasive methods ranging from serum assays to imaging techniques have been developed. Some are validated methods, such as the Fibrotest/ Fibrosure and transient elastography in Europe, and are gaining a growing role in routine clinical practice, especially in chronic hepatitis C. Large-scale validation is awaited in the setting of other chronic liver diseases. However, noninvasive tests used to detect significant fibrosis and cirrhosis, the two major clinical endpoints, are not yet at a level of performance suitable for routine diagnostic tests, and there is still no perfect surrogate or method able to completely replace an optimal liver biopsy. This article aims to review current noninvasive tests for the assessment of liver fibrosis and the perspectives for their rational use in clinical practice.
    Annals of Gastroenterology 03/2012; 25(3):218-231.
Show more