Outpatient Liver Biopsy: How Safe Is It?

Percutaneous liver biopsy is being done more frequently as a result of major changes in the therapy of liver diseases.The ease and safety of outpatient, “blind” liver biopsy has been well established. Complication rates have ranged from 0.9% to 3.7%; most complications have become manifest within the first 3 hours after biopsy, and none has resulted in death. Nevertheless, differing guidelines may affect relative degrees of safety in different Centers. A review of reported series suggests that the Menghini technique may be the preferred first choice, with the Tru-Cut technique reserved for patients in whom an adequate sample cannot be obtained. The requirement of a normal bleeding time appears to decrease the incidence of hemorrhagic complications. The decision to use outpatient biopsy must be based on a careful assessment of the risks and benefits for each individual patient.

Percutaneous needle biopsy of the liver has been performed for more than 100 years. This procedure was first done by Paul Ehrlich in Germany in 1883 [1] for the determination of glycogen in the livers of diabetic patients, and later it was used in tropical medicine to aid in the diagnosis of hepatic abscesses; however, needle biopsy was not widely used because of the high complication rate. Even after the first large series were reported in the 1930s by Huard and colleagues [2] in France and Baron [3] in the United States, the procedure was still regarded with apprehension. Percutaneous liver biopsy was not widely adopted until 1957 when Menghini reported his “1-second” aspiration technique [4], which introduced a needle that shortened the duration of the intrahepatic phase of the biopsy to a fraction of a second. Since then, percutaneous trans-thoracic needle biopsy has been the standard method for obtaining liver tissue. The technique is done “blindly,” usually using either a …