**7. Conclusion**

**5.1. Lack of patient cooperation**

110 Liver Biopsy - Indications, Procedures, Results

Absence of patient cooperation is an absolute contraindication for transparietal LB. Indeed, in case of uncontrolled respiratory movements or agitation of the patient, the biopsy needle may cause a tear in the liver capsule, bleeding or a pneumothorax. If the patient is unable to main‐ tain breath holding, or in the absence of expected cooperation, the question of the appropriate‐ ness of the indication for liver biopsy must be raised. If this indication is maintained, then liver biopsy under general anesthesia might be necessary, eventually via the transvenous route.

It is recommended that transparietal liver biopsy should not be performed if the prothrombin rate is less than 50%, the platelet count is below 50 Giga/L or 60 Giga/L, if activated partial thromboplastine time is greater than 1.5-fold that of the control or when bleeding time is lengthened. The need for maintaining an anticoagulant or an antiplatelet is also a contraindica‐ tion to transparietal LB. Likewise, the existence along the puncture route of a hemangioma or a vascular tumor is a contraindication for liver biopsy without real-time guidance. In this case, ultrasound-guided liver biopsy may eventually be used [1]. For patients with hemophilia, transvenous liver biopsy can be performed safely after correction of anomalies. In this indica‐

The incapacity to detect the liver by percussion or ultrasound is an absolute contraindication

Dilatation of the extrahepatic bile ducts and cholangitis are contraindications to transparie‐

Morbid obesity, severe ascites persisting after evacuation and infection of the right pleural cavity are contraindications for transparietal liver biopsy [1]. The transvenous route can be used in all these settings, and especially in case of significant ascites, morbid obesity, vascu‐ lar liver, anticoagulant or antiplatelet treatment that cannot be stopped, hemodialysis, chronic renal failure or suspicion of amyloidosis when liver biopsy is necessary. Contraindi‐ cations for the transvenous route include bacterial cholangitis, hydatic cyst and uncorrected

Compliance with absolute and relative contraindications for liver biopsy should lead to a decrease in serious accidents due to LB, the presentation of which is beyond the scope of this

**5.2. Hemostasis disorders, history of unexplained bleeding, hemostatic disease**

tion, non-invasive blood markers of fibrosis and FibroScan® are particularly useful.

to performing transparietal liver biopsy, as is suspicion of hydatid cyst.

**5.3. Impossibility of carrying out liver detection**

tal liver biopsy [1].

**5.5. Relative contraindications**

deficits in hemostasis [1, 30].

**6. Reducing the risk of complications**

**5.4. Dilatation of extrahepatic or cholangitic bile ducts**

Liver biopsy remains useful for making an etiological diagnosis and a prognostic evaluation of many non-viral liver diseases, particularly in the context of autoimmune liver diseases, as well as for monitoring liver transplant patients. Liver biopsy is of great value in cases of sev‐ eral associated parenchymal diseases, so as to determine the extent of each, especially in hepatitis C. However, within the setting of isolated hepatitis C without co-morbidity, we feel that first-line LB is no longer appropriate.

The authors declare that they have no conflicts of interest.
