Complications of Liver Biopsy - Risk Factors, Management and Recommendations

The role of liver biopsy (LB), the traditional gold standard for assessing liver disease, continues to evolve1-4. Fewer biopsies are being done for diagnosis as noninvasive tests such as new imaging techniques and accurate serological tests can now be done instead in many cases2-4. Most biopsies are currently performed for parenchymal disease not to make specific diagnosis but to assess the liver damage (the degree of inflammation, fibrosis) or the response to therapy5. In contrast to past when nearly all biopsies were done for diagnostic purpose, presently more than 50% are being done for staging versus 15% for diagnosing the parenchymal liver disease5. In addition, biopsies are often done to help in guiding the management of hepatitis C and nonalcoholic steatohepatitis and to assess the response to therapy2, 3. The increased use of liver transplantation as standard treatment of end stage liver disease of diverse etiologies has led to more biopsies being performed to differentiate the cause of graft dysfunction and to assess the suitability of potential liver donors for transplantation1-3. The dramatic increase in obesity, diabetes, hyperlipidaemia and hypertension (the metabolic syndrome) in western societies and its accompanying fatty liver problems are requiring liver biopsy for histological assessment2. Evaluation of liver histology remains very important as LB is reported to change the clinical diagnosis in 8-14%, management in 12-18% and frequency of liver test monitoring in 36% of cases5. Hence the main indication are a) chronic hepatitisfor grading, staging, establishing a therapeutic strategy and monitoring therapy, b)unexplained abnormal liver function tests or hepatomegaly and c) follow up of patients after liver transplantation. However no liver biopsy is free of risk as it is an invasive procedure. Rational assessment of overall risk in LB however is hampered by the wide variation in the indication and its outcome reported in the existing literature.