Are Biopsies Safe for Patients with Advanced Liver Disease?

Liver biopsies are relatively safe and well tolerated among patients with advanced chronic hepatitis C, based on data from the HALT-C trial

Liver biopsy analysis provides information for diagnosis and planning of treatment strategies for patients with acute and chronic liver diseases, such as chronic hepatitis C infection. However, biopsies are invasive and come with complications such as bleeding, which occurs in 0.8%–1.7% of cases. This risk has been presumed to be higher in patients with advanced liver disease, but a detailed analysis has not been performed until now.

In the October issue of Clinical Gastroenterology and Hepatology, Leonard Seeff et al. analyzed case reports from 2740 liver biopsies of patients with hepatitis C-related bridging fibrosis or cirrhosis who were enrolled in the HALT-C trial at 10 different centers. The rate of serious adverse events in this cohort was 1.2%—no higher than that of other patients, but bleeding was the most common event, occurring in 0.6% of cases. Low levels of albumin, platelet counts of 60,000 mm3 or less, an international normalized ratio (INR) of 1.3 or greater, and esophageal varices all associated significantly with serious adverse events. Seeff et al. calculated that if liver biopsies had been avoided when platelet counts were 60,000 mm3 or less, the incidence of bleeding would have been reduced by 25%.

Bleeding risk should therefore be assessed before patients receive percutaneous liver biopsies.  The authors also observed that patients with histologically proven cirrhosis were no more likely than those with bridging fibrosis to develop a serious adverse event or bleeding.

In an accompanying editorial, Stephen Caldwell and Patrick Northup suggest considering platelet counts, as well as conditions such as hyperfibrinolysis, before performing biopsies. They add that it will be important to identify better measures of the hemostatic system balance in patients with cirrhosis and investigate the roles of pro-coagulants in this important diagnostic procedure.

Computerized tomography showing site of bleeding (arrow) following liver biopsy.

Read the article online.  This article has an accompanying podcast.
Seeff LB, Everson GT, Morgan TR et al. Complication rate of percutaneous liver biopsies among persons with advanced chronic liver disease in the HALT-C trial. Clin Gastroenterol and Hepatol  2010;8:877–883.

Read the accompanying editorial:
Caldwell Sand Northup PG. Bleeding complication with liver biopsy: is it predictable? Clin Gastroenterol and Hepatol 2010;8:826–829.

Read the complementary Gastroenterology article:
West J and Card TR.  Reduced mortality rates following elective percutaneous liver biopsies.  Gastroenterology 2010;139:1230–1237.

About Kristine Novak, PhD, Science Editor

Dr. Kristine Novak is the science editor for Gastroenterology and Clinical Gastroenterology and Hepatology, both published by the American Gastroenterological Association. She has worked as an editor at biomedical research journals and as a science writer for more than 12 years, covering advances in gastroenterology, hepatology, cancer, immunology, biotechnology, molecular genetics, and clinical trials. She has a PhD in cell biology and an interest in all areas of medical research.
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2 Responses to Are Biopsies Safe for Patients with Advanced Liver Disease?

  1. Biljana says:

    Complications such as bleeding, which occurs in 0.8%–1.7% of cases.With three main types of liver biopsy are percutaneous, transvenous, and laparoscopic;and the major risk of liver biopsy is excessive bleeding, called hemorrhage a procedure called embolization can be used to stop the bleeding. In some cases, a blood transfusion is necessary. Surgery can also be used to stop a hemorrhage.People with severe liver disease often have blood clotting problems that can increase the risk of bleeding after the procedure. A medicine given just before a liver biopsy, called clotting factor concentrates, reduces the risk of bleeding in patients with blood clotting abnormalities.
    Maybe with medicine developing these complication will be reduced.

  2. Kristine Novak says:

    Good points – thanks for sharing your comments, Biljana.

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