**Author details**

Claudia Randazzo, Anna Licata and Piero Luigi Almasio

Department of Gastroenterology, University of Palermo, Italy

### **References**


[3] Sorbi D, McGill DB, Thistle JL, et al. An assessment of the role of liver biopsies in asymptomatic patients with chronic liver test abnormalities. Am J Gastroenterol 2000;95:3206-3210.

diagnosis of diffuse parenchymal liver disease is being diminished by accurate blood testing strategies for chronic viral hepatitis, autoimmune hepatitis, and primary biliary cirrhosis. Further, imaging tests are superior to LB in the diagnosis of primary sclerosing cholangitis. However, many cases remain in which diagnostic confusion exists even after suitable labo‐ ratory testing and imaging studies. Diagnosing infiltrative disease (eg, amyloidosis, sarcoi‐ dosis), separating benign fatty liver disease from steatohepatitis, and evaluating liver

Percutaneous LB is contraindicated in patients with severe coagulopathy and ascites, but the degree of coagulopathy that contraindicates a LB is controversial. Also controversial are the technical aspects of LB, particularly the choice of needle (cutting vs. suction) and the use of US to mark or guide the biopsy site. Bleeding is the major complication of LB, with a risk of 0.3%; cutting needles are more likely to cause hemorrhage than are suction needles. While needle biopsy is still the mainstay in diagnosing hepatic fibrosis, its days of dominance seem limited as technology improves. When physical examination or standard laboratory tests reveal clear-cut signs of portal hypertension, LB will seldom add useful information. Similarly, when imaging studies provide compelling evidence of cirrhosis and portal hypertension, needle biopsy is not warranted. The combination algo‐ rithms warrant further evaluation in all chronic liver diseases, as they may help decrease the number of liver biopsies required. Moreover, transient elastography is playing an ev‐ er-increasing role in the assessment of hepatic fibrosis and will significantly reduce the

Clearly, as our knowledge of various liver disorders advances and new especially non-inva‐ sive diagnostic tests are developed, the role of LB in medical practice will continue to evolve. Emergence of better imaging techniques, surrogate serological markers of liver fibro‐ sis are among the many new and exciting developments that hold promise for the future.

[1] Sherlock S. Aspiration liver biopsy: technique and diagnostic application. Lancet

[2] Hay JE, Czaja AJ, Rakela J, Ludwig J. The nature of unexplained chronic aminotrans‐ ferase elevations of a mild to moderate degree in asymptomatic patients. Hepatology

parenchyma after liver transplantation are best accomplished by LB.

need for biopsy in patients with liver disease.

16 Liver Biopsy - Indications, Procedures, Results

Claudia Randazzo, Anna Licata and Piero Luigi Almasio

Department of Gastroenterology, University of Palermo, Italy

**Author details**

**References**

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**Chapter 2**

**Types of Liver Biopsy**

Masatoshi Oya

**1. Introduction**

http://dx.doi.org/10.5772/52914

Nobumi Tagaya, Nana Makino, Kazuyuki Saito, Takashi Okuyama, Yoshitake Sugamata and

Additional information is available at the end of the chapter

chapter introduces these techniques and evaluates their outcomes.

**2. Percutaneous Liver Biopsy (PLB)**

son with blind PLB [21].

Liver biopsy (LB) is an important procedure in the diagnosis and treatment of liver diseases. However, procedures for performing LB vary amongst institutions, and no universal guide‐ lines exist. LB is performed for two main reasons: diagnosis of a liver condition itself, and as an adjunct to an existing surgical procedure. Recently, it has become possible to employ both approaches with minimal invasiveness using the transjugular route or under the guid‐ ance of ultrasound, computed tomography, or laparoscopic and endoscopic ultrasound. Techniques for liver tissue sampling include percutaneous liver biopsy [1-6], transjugular liver biopsy [7-14], laparoscopic liver biopsy [15], and transgastric liver biopsy [16-20]. This

PLB is performed either blind or under imaging guidance. In the latter context, ultrasound (US) or computed tomographic (CT) guidance is used. Although these results of US-guided PLB depend greatly on the skills of the gastroenterologist, hepatologist or radiologist and the technical capabilities and quality of the US instrument, the available data indicate that it has a lower complication rate, requires a lower number of passes, is associated with less pain and pain-related morbidity, has a lower likelihood of the need for a repeat procedure, affords better-quality tissue specimens, and has only a marginally increased cost in compari‐

> © 2012 Tagaya et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

© 2012 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

distribution, and reproduction in any medium, provided the original work is properly cited.

and reproduction in any medium, provided the original work is properly cited.

