Liver biopsy in patients with marked coagulopathy

liver411

Am J Gastroenterol 2003 Apr;98(4):893-900

Liver assessment and biopsy in patients with marked coagulopathy: value of
mini-laparoscopy and control of bleeding.

Denzer U, Helmreich-Becker I, Galle PR, Lohse AW
First Department of Medicine, Johannes Gutenberg-University, Mainz, Germany.

OBJECTIVE: Evaluation of liver disease in patients with a high risk of
postbiopsy bleeding presents a diagnostic challenge. Mini-laparoscopy offers
the possibility of coagulation of biopsy site and the additional advantage
of macroscopic liver assessment. We wished to assess the value and safety of
mini-laparoscopy with guided biopsy as a diagnostic approach in patients in
whom percutaneous liver biopsy is considered contraindicated because of a
marked coagulopathy. METHODS: We investigated 61 consecutive patients with
marked coagulopathy (prolonged international normalized ratio > 1.5,
thrombocytopenia < 50/nl, or both; von Willebrand's disease/hemophilia).
Diagnostic mini-laparoscopy with visually guided liver biopsy was undertaken
for the evaluation of liver disease. Biopsy sites were coagulated
prophylactically (n = 4) or therapeutically (n = 52). Safety, diagnostic
yield, and therapeutic consequences were assessed. RESULTS: Macroscopic
assessment of the liver was possible in 60/61 high-risk patients and was
considered diagnostic in 1/61. In 58 of the remaining 60 patients, liver
biopsy was technically feasible. There was no persistent postbiopsy
bleeding. One patient with fulminant hepatic failure had self-limiting
bleeding from the abdominal wall. Ninety-seven percent of the biopsies were
of adequate size for diagnostic histological evaluation. CONCLUSIONS:
Mini-laparoscopy with guided liver biopsy allows reliable and safe
evaluation of liver disease in patients with severe coagulopathy.

Publication Types:


Validation studies
PMID: 12738474, UI: 22623038