Percutaneous liver biopsy using an ultrasound-guided subcostal route

Percutaneous biopsy is considered one of the most important diagnostic tool s to evaluate diffuse liver diseases. The introduction and widespread diffu sion of ultrasounds in medical practice has improved percutaneous bioptic t echnique, while reducing postoperative complications. Although ultrasonogra phy has become almost ubiquitous in prebiopsy investigation, only one third of biopsies are performed under ultrasound control. Moreover, the one-day procedure, reported in several studies to be safe and cost effective, accou nted for only 4% of biopsies done. We report our experience of 142 percutan eous US-guided biopsies performed on 140 patients affected by chronic diffu se liver disease over a four-year period. Liver biopsies were performed und er US guidance at the patient's bed using an anterior subcostal route. We e valuated postoperative pain, modifications of blood pressure and red cell c ount, hospital stay, morbidity and mortality rates, and adequacy of specime ns for histologic examination. There was no operative mortality. As for maj or complications, one case of hemobilia occurred. As for minor complication s, two cases of persistent postoperative pain required analgesic therapy. P atients were discharged the day following the procedure in all cases but tw o, who were discharged on the third and fifth postoperative days. Liver spe cimens were suitable for histologic diagnosis in all but one case, in which there were no portal spaces. According to our experience, we believe that hepatic biopsy guided by ultrasonography could replace blinded biopsy in th e diagnosis of diffuse liver disease. The procedure is suitable to be perfo rmed safely on an outpatient basis.