Percutaneous Liver Biopsy Practice Patterns Among Canadian Hepatologists

BACKGROUND: Percutaneous liver biopsy (PLB) is the standard procedure to obtain histological samples essential for the management of various liver diseases. While safe, many hepatologists no longer perform their own PLBs; the reasons for this practice shift are unknown.OBJECTIVE: To describe the attitudes, practice patterns and barriers to PLB among hepatologists in Canada.METHODS: A survey was distributed to all hepatologists in Canada.RESULTS: Thirty-two of 40 (80%) hepatologists completed the survey; the majority of respondents were male (72%) and had been in practice for >5 years in an academic setting. Fifty-six per cent of hepatologists referred all PLBs to radiology, and only 19% of hepatologists reported performing their own PLBs most or all of the time. There were no sex differences nor were there differences based on years in practice. Fifty per cent of respondents who performed PLB routinely used ultrasound, and PLBs are performed in equal frequency in an ambulatory procedure area (50%) versus the endoscopy suite (36%). For almost one-half of hepatologists (47%), their performance of PLBs decreased in the past five years. The majority of respondents at an academic centre (75%) reported access to FibroScan (Echosens, France), and most estimated a resultant 25% to 50% reduction in the need for PLBs. Lack of resources, patient preference and suboptimal reimbursement were the most common reasons cited for not performing PLBs.CONCLUSION: Most hepatologists in Canada do not perform PLBs to the extent that they did in the past, but refer to radiology. The reasons for this shift in practice include lack of resources, improved perception of safety and patient preference. Where available, FibroScan resulted in a perceived 25% to 50% reduction in required liver biopsies.

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PERCUTANEOUS LIVER BIOPSY PRACTICE PATTERNS AMONG PEDIATRIC GASTROENTEROLOGISTS IN NORTH AMERICA: RESULTS OF A WEB-BASED SURVEY

Journal of Pediatric Gastroenterology and Nutrition ◽

10.1097/01.mpg.0000181961.69698.ae ◽

2005 ◽

Vol 41 (4) ◽

pp. 525

Author(s):

Sanjoy Banerjee ◽

Jenifer Lightdale ◽

Warren Bishop

Keyword(s):

North America ◽

Liver Biopsy ◽

Practice Patterns ◽

Percutaneous Liver Biopsy ◽

Web Based

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Value and risk of percutaneous liver biopsy in patients with cirrhosis and clinical suspicion of autoimmune hepatitis

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2021-000701 ◽

2021 ◽

Vol 8 (1) ◽

pp. e000701

Author(s):

Pimsiri Sripongpun ◽

Ananya Pongpaibul ◽

Phunchai Charatcharoenwitthaya

Keyword(s):

Liver Biopsy ◽

Autoimmune Hepatitis ◽

Significant Risk ◽

Clinical Information ◽

Diagnostic Information ◽

Overlap Syndrome ◽

Clinical Suspicion ◽

Primary Biliary Cholangitis ◽

Percutaneous Liver Biopsy ◽

Liver Biopsies

ObjectiveThe decision regarding whether to perform a liver biopsy in patients with cirrhosis and clinically suspected autoimmune hepatitis (AIH) remains a challenge. This study aimed to assess the utility and complications of percutaneous liver biopsy in cirrhosis for differentiating AIH from other liver conditions.MethodsA clinicopathological database of patients undergoing percutaneous liver biopsies for suspected AIH (unexplained hepatitis with elevated γ-globulin and autoantibody seropositivity) was reviewed to identify patients presenting with cirrhosis. Biopsy slides were reviewed by an experienced hepatopathologist who was blinded to clinical data.ResultsIn 207 patients who underwent liver biopsy for suspected AIH, 59 patients (mean age: 59.0±12.0 years, 83.1% female) had clinically diagnosis of cirrhosis. Mean Child-Turcotte-Pugh score was 6.6±1.6, and 44% of patients had a Child-Turcotte-Pugh score≥7. According to the revised International AIH Group (IAIHG) criteria, histology assessment combined with clinical information facilitated a diagnosis of AIH or overlap syndrome of AIH and primary biliary cholangitis (PBC) in 81.4% of cases. Liver biopsy identified other aetiologies, including PBC (n=2), non-alcoholic steatohepatitis (n=6) and cryptogenic cirrhosis (n=3). A reliable diagnosis of AIH could be made using histological category of the simplified criteria in 69.2% and 81.8% of cases using IAIHG scores before biopsy of <10 and 10–15, respectively. Three patients with cirrhosis (5.1%) experienced bleeding following biopsy, but none of 148 patients with non-cirrhosis had bleeding complication (p=0.022).ConclusionLiver biopsy provides important diagnostic information for the management of patients with cirrhosis and suspected AIH, but the procedure is associated with significant risk.

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Imaging-guided Parenchymal Liver Biopsy: How We Do It

Journal of Clinical Imaging Science ◽

10.4103/2156-7514.82082 ◽

2011 ◽

Vol 1 ◽

pp. 30 ◽

Cited By ~ 16

Author(s):

Gopal R Vijayaraghavan ◽

Sheehan David ◽

Myriam Bermudez-Allende ◽

Hussain Sarwat

Keyword(s):

Liver Biopsy ◽

Standard Procedure ◽

Treatment Strategies ◽

Specific Treatment ◽

Cost Effective ◽

The United States ◽

Left Lobe ◽

Comfort Level ◽

Parenchymal Liver ◽

Liver Biopsies

Liver biopsies are performed for both focal and nonfocal lesions (parenchymal). In our center, majority of liver biopsies are performed for parenchymal liver disease. Parenchymal liver biopsy plays a key role in the diagnosis of various diffuse liver dysfunctions. Results of the biopsy help grade the disease, facilitating prognostication, which helps in planning specific treatment strategies. Imaging guidance is gaining wide acceptance as the standard procedure. Ultrasound (US) guidance is currently considered the most cost-effective and safe way to perform parenchymal liver biopsies. Radiologists worldwide and particularly in the United States are increasingly performing this procedure. Radiologists performing biopsies generally use the cutting needle. Different needle sizes, techniques and preference for biopsy of the right or left lobe have been described. We attribute these preferences to prior training and individual radiologist's comfort level. We describe the algorithm followed at our institution for performing percutaneous US-guided parenchymal liver biopsy. While clinical societies have recommended a minimum of 40 liver biopsies as a requirement for proficiency of clinicians, specific to radiology trainees/fellows interested in pursuing a career in intervention, we feel a total of 20 liver biopsies (includes assisted and independently performed biopsies under supervision) should be adequate training.

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Serotonin Syndrome in a Patient on Trazodone and Duloxetine Who Received Fentanyl following a Percutaneous Liver Biopsy

Case Reports in Gastroenterology ◽

10.1159/000382069 ◽

2015 ◽

Vol 9 (2) ◽

pp. 132-136 ◽

Cited By ~ 7

Author(s):

Ryan R. Gaffney ◽

Ian R. Schreibman

Keyword(s):

Liver Biopsy ◽

Serotonin Syndrome ◽

Signs And Symptoms ◽

Percutaneous Liver Biopsy ◽

Increased Risk ◽

Life Threatening ◽

Sedation And Analgesia ◽

Missed Diagnosis ◽

Liver Biopsies ◽

Medical Intensive Care

Serotonin syndrome is a rare but potentially life-threatening adverse drug reaction resulting from the use or overuse of serotonergic medications alone or in combination. Mild symptoms, overlapping features with similar conditions and clinician lack of awareness are the major reasons for an often missed diagnosis. Not surprisingly, this condition is significantly underreported as a potential complication of endoscopy if serotonergic medications are used periprocedurally for sedation and analgesia. Here we report the case of a patient with relapsed chronic hepatitis C on antidepressant medications who developed signs and symptoms of serotonin syndrome after a percutaneous liver biopsy. Review of the patient's medication list suggested a possible interaction between her home antidepressants and the post-procedure use of fentanyl for abdominal pain. The patient required monitoring in the medical intensive care unit and stabilized after the administration of benzodiazepines and temporary discontinuation of her home medications. We propose that clinicians need to be aware of the increased risk of serotonin syndrome in the outpatient endoscopy setting, particularly with the wider use of serotonergic antidepressants now available and the repeated number of liver biopsies being performed for management of patients with chronic liver disease.

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Complications and Efficiency of Liver Biopsies using the Tru-Cut Biopsy Gun

The Journal of Infection in Developing Countries ◽

10.3855/jidc.572 ◽

2009 ◽

Vol 4 (02) ◽

pp. 091-095 ◽

Cited By ~ 3

Author(s):

Figen Caglan Cevik ◽

Nevil Aykin ◽

Hasan Naz

Keyword(s):

Liver Biopsy ◽

Chronic Viral Hepatitis ◽

Percutaneous Liver Biopsy ◽

Ultrasound Guided ◽

Biopsy Site ◽

Major Complications ◽

Significant Difference ◽

Liver Biopsies ◽

Liver Bleeding

Objectives: The study aimed to evaluate the complications and quality of the specimens of percutaneous liver biopsy in patients with chronic viral hepatitis who were scheduled for treatment and also to evaluate the contribution of the knowledge of ultrasound guided (USG) biopsy localization to the existing data. Methodology: Liver biopsies conducted at our clinic between 2003 and 2008 were retrospectively evaluated. In 53.8% of the cases, hepatobiliary USG was performed to mark the localization of the biopsy site. An automatically triggered Tru-Cut biopsy gun was used. Results: Biopsies waere taken from the livers of 236 patients (46.6% male, 53.4% female) with a mean age of 47.1 ± 12.5 years. The majority of patients had hepatitis C (61.9%); 1.6% experienced major complications (3 patient biliary peritonitis, 1 patient liver bleeding); 52.1% of the samples were ≥ 1 cm in length; And 69.7% of the biopsy samples with specified portal area had ≥ 4 portal areas. There was no statistically significant difference between the patients with localized and non-localized biopsy site in terms of major complications and length of biopsy samples ( respectively p = 1.000, p = 0.209 ). Conclusion: We believe that percutaneous liver biopsy using Tru-Cut biopsy gun can be peformed safely, with complications in 1.6% of the procedures. The length of the biopsy specimen is shorter than ideal values. Evaluation of the patients with and without USG-guided biopsy revealed no significant difference in terms of major complications and specimen size.

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Percutaneous Liver Biopsy Practice Patterns Among Pediatric Gastroenterologists in North America

Journal of Pediatric Gastroenterology and Nutrition ◽

10.1097/mpg.0b013e318053eab4 ◽

2007 ◽

Vol 45 (1) ◽

pp. 84-89 ◽

Cited By ~ 7

Author(s):

Sanjoy Banerjee ◽

Warren Bishop ◽

Clarissa Valim ◽

Lisa B Mahoney ◽

Jenifer R Lightdale

Keyword(s):

North America ◽

Liver Biopsy ◽

Practice Patterns ◽

Percutaneous Liver Biopsy

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Blood Transfusion Requirements after Liver Biopsy

Canadian Journal of Gastroenterology ◽

10.1155/2000/951962 ◽

2000 ◽

Vol 14 (10) ◽

pp. 901-902

Author(s):

Brian D O’Brien

Keyword(s):

Blood Transfusion ◽

Liver Biopsy ◽

Tertiary Care ◽

Fatal Outcome ◽

Health Record ◽

Percutaneous Liver Biopsy ◽

Transfusion Requirements ◽

Risk Patients ◽

Liver Biopsies ◽

Record Review

It is common practice to type and screen the blood before performing a percutaneous liver biopsy. Many practitioners think that this is unnecessary but do not have a reason to change their practice. The requirements for transfusion after biopsy were determined in a consecutive sample of cases at a tertiary care teaching hospital with the use of health record review and the anecdotal recall of gastroenterologists and others performing biopsies. One of 266 liver biopsies required a transfusion after biopsy over a two-year period. One other case of hemorrhage with a fatal outcome was recalled by several individuals. It is concluded that the incidence of significant hemorrhage after liver biopsy is low, and that it may not be necessary to type and screen the blood of low risk patients before biopsy.

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