LIVER-BIOPSY - REVIEW OF METHODOLOGY AND COMPLICATIONS

Liver biopsy remains an essential tool to confirm a suspected diagnosi s and guide specific therapy in patients with liver disease. The metho ds available to obtain liver tisse include percutaneous needle biopsy, transjugular biopsy, image-guided needle biopsy, and laparoscopic dir ect vision guided needle biopsy. Advantages and disadvantages of each modality are reviewed herein. The indications for liver biopsy include evaluation of elevated aminotransferases, assessment of response to t herapy of chronic liver disease, monitoring for hepatoxicity of drug t herapy, and liver transplant allograft evaluation. Contraindications i nclude impaired coagulation, significant ascites, high-grade extrahepa tic biliary obstruction, echinococcal cyst, and certain anatomic abnor malities. Complications include pain, hemorrhage, bile peritonitis, pe netration of abdominal viscera, pneumothorax, and death. Complications are reported in 0.06-0.32% of the patients. Death as a direct result of liver biopsy is extremely rare (0.009-0.12%). In properly selected patients, liver biopsy has a high benefit/risk ratio and is often cons idered the final and definitive diagnostic test.