PRACTICE AND COMPLICATIONS OF LIVER-BIOPSY - RESULTS OF A NATIONWIDE SURVEY IN SWITZERLAND

Studies on the complication rate of liver biopsy have hitherto been co nducted in referral hospital centers. They are therefore not represent ative for general practice where liver biopsy is performed by speciali sts and nonspecialists. In a postal nationwide survey, we approached a ll gastroenterologists and hospital internists to assess the complicat ion rate and practice (setting, needle type, use of ultrasonography) o f percutaneous liver biopsy performed in 1989 in Switzerland for diffu se liver disease. Two hundred eighty questionnaires were mailed and 25 2 were returned (response rate 90.0%) 165 respondents (65.5%) performe d 3501 biopsies while 87 respondents (34.5%) did not practice liver bi opsy; 67.7% of biopsies were executed blindly and 32.3% were guided. E ight nonfatal and three fatal complications occurred. Hemorrhage was t he most frequent complication (five cases) and was responsible for all three fatal outcomes. The overall complication rate was 0.31%, being distinctly lower in the group of gastroenterologists (0.11%) as compar ed to the group of internists (0.55%; P = 0.031). The complication rat e was 1.68% in the group of internists performing fewer than 12 biopsi es per year, while there was no complication in the group of internist s performing more than 50 biopsies per year (P = 0.036). Complications were not related to the needle diameter or to the absence of ultrason ography before biopsy. In conclusion, this representative survey in Sw itzerland shows that the complication rate of liver biopsy is mainly r elated to the experience and training of the operator.