Although percutaneous liver biopsy is a standard diagnostic procedure, it has drawbacks, including risk of serious complications.
It is not known whether persons with advanced chronic liver disease have a greater risk of complications from liver biopsy than patients with more mild, chronic liver disease.
Dr Leonard Seeff and colleagues from Massachusetts, USA examined the safety and complications of liver biopsy in patients with hepatitis C–related bridging fibrosis or cirrhosis who were enrolled in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis trial.
Standard case report forms from 2740 liver biopsies performed at 10 study sites between 2000 and 2006 were reviewed for serious adverse events, together with information from questionnaires completed by investigators about details of biopsy techniques used at each hospital.
There research team observed 29 serious adverse events.
Operator experience did not influence the frequencies of adverse events
Clinical Gastroenterology & Hepatology
The most common adverse event was bleeding, and there were no biopsy-related deaths.
The bleeding rate was higher among patients with platelet counts of 60,000/mm3 or less, and among those with an international normalized ratio of 1.3 or greater, although none of the patients with an international normalized ratio greater than 1.5 bled.
The team noted that excluding subjects with a platelet count of 60,000/mm3 or less would have reduced the bleeding rate by 25%, eliminating only 3% of biopsies.
Operator experience, the type of needle used, or the performance of the biopsy under ultrasound guidance did not influence the frequencies of adverse events.
Dr Seeff's team concluded, "Approximately 0.5% of persons with hepatitis C and advanced fibrosis experienced potentially serious bleeding after liver biopsy."
"The risk increased significantly in patients with platelet counts of 60,000/mm3 or less."
Clin Gastroenterol Hepatol 2010: 8(10): 877-83
12 October 2010
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