Liver biopsy: review of methodology and complications

Liver biopsy remains an essential tool to confirm a suspected diagnosis and guide specific therapy in patients with liver disease. The methods available to obtain liver tissue include percutaneous needle biopsy, transjugular biopsy, image-guided needle biopsy, and laparoscopic direct vision guided needle biopsy. Advantages and disadvantages of each modality are reviewed herein. The indications for liver biopsy include evaluation of elevated aminotransferases, assessment of response to therapy of chronic liver disease, monitoring for hepatoxicity of drug therapy, and liver transplant allograft evaluation. Contraindications include impaired coagulation, significant ascites, high-grade extrahepatic biliary obstruction, echinococcal cyst, and certain anatomic abnormalities. Complications include pain, hemorrhage, bile peritonitis, penetration of abdominal viscera, pneumothorax, and death. Complications are reported in 0.06-0.32% of the patients. Death as a direct result of liver biopsy is extremely rare (0.009-0.12%). In properly selected patients, liver biopsy has a high benefit/risk ratio and is often considered the final and definitive diagnostic test.