Liver Biopsy - Indications, Procedures, Results

Liver biopsy (LB) is the most common procedure performed in clinical hepatology. His‐ tological assessment of the liver, and thus, LB is traditionally the “reference standard” in the diagnosis and management of parenchymal liver diseases. Definitive diagnosis of‐ ten depends on LB, and much of understanding of the characteristic features and natu‐ ral history of liver diseases is based on information obtained by serial liver biopsies. During the last 60 years as the result of a better understanding of liver disorders, ap‐ pearance of newer entities and advent of novel hepatic imaging techniques, the indica‐ tions for LB have evolved. Whereas in the past LB was often performed as the initial investigation in the workup of liver disease of unknown aetiology, today the most com‐ mon indication for LB includes staging of chronic hepatitis. A variety of methods exist for getting a liver tissue specimen. These take account of a percutaneous method, a transvenous (transjugular or transfemoral) approach, and intra-abdominal biopsy (laparo‐ scopic or laparotomic). All LB techniques require specific training so as to ensure appro‐ priate-sized specimen retrieval and the lowest rate of complications. However, because LB is an invasive procedure that carries a definite, albeit small, risk of complications, controversy persists with regard to its precise indications in various clinical situations, its clear contraindications, the optimal technique for its performance (and whether cer‐ tain modifications improve its safety), and training requirements for clinicians. The aim of this chapter will be summarize the existing clinical practice of LB with an emphasis on the technique, indications, contraindications, quality of LB specimens and risk of complications.