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.