Clinical

Liver biopsy complications rare at experienced centers

Last Updated: 2010-04-16 13:30:10 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - Liver biopsy complication rates are low at experienced centers -- although as might be expected, lower platelet counts are associated with higher risk of bleeding, according to a multicenter study.

"It is our belief that liver biopsies, at least among persons with advanced but otherwise compensated chronic hepatitis C, can be undertaken reasonably safely, but should not be done when the platelet count is less than 60,000," lead author Dr. Leonard B. Seeff told Reuters Health by email.

Liver biopsy, "has recently lost some of its glamour for several reasons," Dr. Seeff said. "First, there is a developing belief that some noninvasive procedures might offer almost as much information as performing a liver biopsy, a view not universally shared. Second, there are concerns that the procedure has potential for causing side effects that include bleeding and, rarely, even death."

Nevertheless, biopsies are necessary to diagnose certain conditions, and as Dr. Seeff and his colleagues point out, liver histology is a mandatory endpoint in clinical trials of therapies for liver disease.

In their April 16th online paper in Clinical Gastroenterology and Hepatology, the researchers report on 2740 percutaneous liver biopsies performed at 10 centers in the U.S. All were done in patients with advanced chronic hepatitis C who were enrolled in the HALT-C trial of peginterferon alfa-2a maintenance therapy.

There were no biopsy-associated deaths, but 63 patients (2.3%) had complications. Complications were serious in 1.1%. About half of the serious complications involved bleeding, about a quarter involved severe pain. Other severe complications included gallbladder puncture, hypotension, pneumothorax, and syncope. Most of the non-serious complications involved transient pain at the biopsy site.

The bleeding rate was higher when platelet counts were 60,000/mm 3 or less and when patients had an international normalized ratio (INR) of 1.3 or more. However, no patient with an INR above 1.5 had bleeding.

"There was not much difference in the frequencies (of adverse events) among the various participating centers," continued Dr. Seeff, "nor were there significant differences based upon operator experience, the type of needle used, or the use of ultrasound guidance."

However, he and his colleagues point out, biopsies were done "largely by experienced hepatologists in outpatient facilities, mostly under ultrasonic guidance" with conscious sedation and most often with a cutting needle.

Although it's uncertain whether these findings would also apply to patients with other liver diseases, in these patients at least, "despite their advanced chronic liver disease," biopsy was "safe and well tolerated," the researchers conclude.

Clin Gastroenterol Hepatol 2010.