Ultrasound assisted liver biopsy for the staging of diffuse chronic hepatopathies

Liver biopsy is the most accurate method for the staging and grading of diffuse hepathopathies. In viral hepatitis staging is required in order to assess firstly if the patient should be treated or not and, secondly, to assess the prognosis. In alcoholic and non-alcoholic steato-hepatitis we only appreciate the prognosis by staging, because the therapy is the same. In this study we analyze the experience of our centre in performing ultrasound-assisted liver biopsies in diffuse chronic hepatopathies. Between 1993-2003 we performed 1460 ultrasound-assisted liver biopsies, all on inpatients, in 93.8% of the cases for the evaluation of viral hepatitis. In the last few years we used sedation with midazolam i.v., the saturation of O(2) being recorded. In the 10 years of the study we encountered one major complication (haemo-peritoneum) (0.07%), treated by conservative methods. The minor complications we encountered, pain and discomfort, were always alleviated by minor analgesics. Vaso-vagal reactions were frequent before we started using midazolam (8.05%), but were no longer present after we performed sedation. None of the liver biopsies was followed by the death of the patient. In 1.37% of the cases we obtained inadequate liver specimens. We performed multiple passages in 0.96% of the cases. In conclusion, ultrasound-assisted liver biopsy is still the "gold standard" of hepatologic evaluation, being a safe and accurate method for staging the diffuse chronic hepatopathies.