Dr Jean-Francois Cadranel and colleagues at the French Association for the Study of the Liver, Paris, France, analyzed 2084 liver biopsies, to evaluate different practices and the subsequent outcomes and complications. The biopsies were performed at 89 major French liver centers.
Practice analysis focused on the locus of operation, experience levels of operators, indications for biopsy, and biopsy techniques - particularly route, anesthesia and use of ultrasound.
Operators recorded technical complications and subjective assessment of pain, anxiety and discomfort levels were made independently, using visual analogue scales.
72% of biopsies were performed by experienced operators (> 150 biopsies), but ultrasound guidance was used for only 56% of the biopsies. Hepatitis C infection (54%) was the most common indication. 27% were biopsied as a day case.
Severe complications after 1 in 175 biopsies - particularly multiple passes.
No deaths occurred, but severe complications occurred after 1 in 175 biopsies - particularly after multiple passes. There were less complications when the operator was experienced, atropine was given, and ultrasound used.
Dr Cadranel concludes that, while there is great variation in accepted procedures across France, patients generally would prefer a day-case biopsy, and safety would improve with the widespread use of ultrasound guidance.