Liver outpatient biopsy

Many investigators have reported in the literature on their wide experience concerning outpatient liver biopsy. (22, 35, 36, 43, 49, 70, 76, 88, 106, 167, 174) E. Richter et al. (1972), K. Teubner (1975) and H. Thaler (> 4,000 complication-free outpatient biopsies ) have also reported on this subject. Additional statements have been made by R. Decking (1991) (30), the latter following recommendations issued by the Patient Care Committee (W H. Jacobs et af, 1989). More recent results obtained by A. Giger et al. (1993) (50) and S. Vivas et al. (1998) further advocate this method. The Jamshidi needle also proved to be low in risk. 

Isolated instances of objections to outpatient biopsies are neither objectively nor legally justifiable, provided the necessary criteria are duly observed. Besides the paramount requirement concerning the qualification of the investigating physician, we have always been in favour of and have insisted on restricted indications with expanded contraindications . In contrast to percutaneous liver biopsy under hospital conditions, outpatient percutaneous biopsy calls for normal blood coagulation parameters. We have extended the list of contraindications (s. tab. 7.4) to include some additional points, (s. tab. 7.8)... 

A physieal examination is necessary to find out if the organs are functioning properly. Blood, urine and bone marrow tests may also be done. A small tissue sample (biopsy) may be taken from the rectum, abdominal fat or bone marrow to determine if the person has amyloidosis. These biopsies are relatively minor procedures done in an outpatient setting with a local anesthetic. Occasionally, samples are taken from the liver, nerve, heart or kidney. This may require hospitalization and can help diagnose the specific oi an affected by amyloidosis. Blood or urine tests can detect the protein, but only bone marrow tests or other small samples of tissue can positively establish the di nosis of amyloidosis. 

Indications and contraindications in children are the same as in adults. In general, the diameter of the needle should not exceed 1.2 mm. Premedication is advisable to ensure a smooth (and hence low-risk) biopsy. D. Feist et al. (1972) reported on 385 biopsies with just one complication (no fatal cases) (40), and H. Thaler (1979) observed only 2 minor complications in 764 biopsies (159), while M. B. Cohen et al. (1992) reported a lethality rate of 0.60%, slight complications in 11.7% and serious events in 4.5% of cases. (25) A.o. ScHEiNMANN et al. found complications in 6.83% of cases, of which 2.4% were severe lethality was 0.4%. (137) Liver biopsies have also been successfully carried out in children under outpatient conditions. (53)... 

Tab. 7.8 Additional contraindications for outpatient liver biopsy (complementary to table 7.4)...

Chawla, Y.K., Ramesh, G.N., Kaur, U., Bambery, R, Dilawari, J.B. Percutaneous liver biopsy a safe outpatient procedure. X. Gastroenterol. Hepatol. 1990 5 94-95... 

Gonzalez-Vallina, R., Alonso, E.M., Rand, E., Black, D. D., Whiting-ton, P.F. Outpatient percutaneous liver biopsy in children. X Pediatr. Gastroenterol. Nutrit. 1993 17 370-375... 

Janes, Ch.H., Lindor, K.D. Outcome of patients hospitalized for complications after outpatient liver biopsy. Ann. Intern. Med. 1993 118 96-98... 

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