INTRODUCTION
Histological evaluation has a crucial role in diagnosing the etiology and severity of hepatic diseases, liver tumors, and is useful in the follow-up after liver transplantation 1,2. The effectiveness of this tool relies on a safe removal of the specimen and suitable provision of clinical and laboratory data to the pathology staff1-3.
Several routes are available, such as laparoscopic, endoscopic, or transjugular 4 but percutaneous liver biopsy (PLB) is generally preferable since it is less invasive and less costly compared to other routes 2. Coagulation impairment, low platelets, ascites, or anatomical changes are also important in this choice 1. Physicians may use three different approaches: palpation/percussion-guided, image-guided, and real-time image-guided, most commonly ultrasound (US). Real-time US guidance seems to reduce the risk of adverse events (AEs) and this makes PLB safe to perform 2,3, whether by radiologists5 or by gastroenterologists and hepatologists6.
Although the pain has been commonly reported after PLB (30 – 50%), it is usually mild, self-limited, or has a good response to analgesics4,7. The incidence of serious complications is low, not exceeding 6% 8,9. Approximately 60% of these events occur within the first 2 hours and 96% in the 24 hours following the procedure 10. The reported incidence of bleeding ranges from 0.5 to 1.8% 11, but it can be serious and lead to death if prompt treatment is not carried out1,10.
In recent years, the main indication for PLB has been the evaluation of hepatitis C virus (HCV) chronic infection, either to exclude other etiologies of hepatic damage or to establish the histological stage of fibrosis and set the appropriate therapy 12. However, that need has been reducing in the era of non-invasive assessment of liver fibrosis and direct-acting antiviral drugs 13.
There are few reports on the purpose and safety of real-time US-guided PLB performed by hepatologists in a large outpatient cohort. We aim to describe the indications, as well as the rate and severity of biopsy-related AEs in a 5-year study.