VARIATION BETWEEN CENTERS IN TECHNIQUE AND GUIDELINES FOR LIVER-BIOPSY

Hospitals have few published guidelines to follow when performing a li ver biopsy. In 1992, we began revising our protocol in an effort to in stitute new guidelines for our teaching hospitals. To assess the curre nt practice of liver biopsy, we sent 500 multilingual questionnaires t o international academic centers, and 85 U.S. centers were surveyed by telephone. The survey assessed: 1) patient preparation, 2) technical aspects of the biopsy, and 3) post-procedural care. One hundred and ei ghty international centers and 85 U.S. centers responded (total=265). We found a wide variation in the practice of this surgical procedure a t both national and international centers. Many Asian centers (73%) pe rformed a bleeding time prior to liver biopsy. This practice was seen in only 36% of the U.S. centers. Most centers preferred platelet count s of 50,000/mm(3) and above. The aspiration needle was more widely use d in the U.S. (74%) and in many international centers, but Asian cente rs (61%) preferred a cutting needle. Thirty percent of Japanese center s performed more than 50% of their liver biopsies laparoscopically. Fe w laparoscopies were done at other centers. While about a quarter of t he reported U.S., European, Asian, and South American centers observed patients for 4-6 hours after a biopsy, the majority of centers observ ed patients 10 hours or more. In addition to the wide variation seen, this survey provided us with an academic view of the contemporary prac tice of liver biopsy and an insight into how to redefine our present g uidelines. (C) Munksgaard, 1996.