Liver biopsy: complications and risk factors

TLDR

The study aimed to evaluate complications and risk factors of percutaneous liver biopsy and compare rates between 1987‑1993 and 1994‑1996, noting a decline in mortality with increased experience. The authors retrospectively reviewed medical records of 484 percutaneous liver biopsies performed at Songklanagarind Hospital from 1987 to 1996. The study found a 6.4% overall complication rate (4.5% major bleeding, 1.6% mortality), identified low platelet count, prolonged PT, and prolonged aPTT as key risk factors, and observed a drop in mortality from 2.2% to 0% with increased senior staff experience, underscoring the need for pre‑procedure screening and expert supervision.

Abstract

AIM:To study the complications and the risk factors of percutaneous liver biopsy, and to compare the complication rate between the periods of 1987-1993 and 1994-1996.METHODS:Medical records of all patients undergoing percutaneous liver biopsy between January 1, 1987 to September 31, 1996 in Songklanagarind Hospital were reviewed retrospectively.RESULTS:There were 484 percutaneous liver biopsies performed. The total complication rate was 6.4%, of which 4.5% were due to major bleeding; the death rate was 1.6%. The important risk factors correlated with bleeding complications and deaths were a platelet count of 70X10(9)/L or less, a prolonged prothrombin time of >3seconds over control, or a prolonged activated partial thromboplastin time of > 10 seconds over control. Although physician inexperience was not statistically significantly associated with bleeding complications and deaths, there was a reduction of death rate from 2.2% in 1987-1993 to 0% in 1993-1996. This reduction is thought to result from both increased experience of senior staff and increased supervision of residents.CONCLUSIONS:Screening of platelet count, prothrombin time, and activated partial thromboplastin time should be done and need to be corrected in case of abnormality before liver biopsy. Percutaneous liver biopsy should be performed or supervised by an expert in gastrointestinal diseases, especially in high risk cases.