**5. Absolute and relative contraindications for LB**

Absolute and relative contraindications for LB depend on the surgical approach recom‐ mended. Contraindications for liver biopsy using the transjugular or transparietal route [1, 30] are summarized in Table 4.

### **5.1. Lack of patient cooperation**

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.

paper. Liver biopsy is an invasive procedure with the possible risk of severe complications, approximately 0.5/1,000 [1, 30]. Liver biopsy is a procedure for which there exists residual mortality [32]. Although serious complications have decreased over time, mortality after performing transparietal liver biopsy remains at 0.2% and deaths related to liver biopsy for diffuse parenchymal liver amount to 1 out of 10,000 LB [32].This risk, however, has de‐ creased dramatically over time because of improvement in indications for liver biopsy and

Current Trends in Liver Biopsy Indications for Chronic Liver Diseases

http://dx.doi.org/10.5772/52618

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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

compliance with contraindications [32].

feel that first-line LB is no longer appropriate.

tology. 2009; 49(3):1017-44..

consensus. Gut. 2003; 52(12):1784-7.

study. Lancet. 2001; 357(9262):1069-75.

hepatitis C. Journal of hepatology. 2007; 46(5):775-82.

The authors declare that they have no conflicts of interest.

and Jean-Baptiste Nousbaum2

2 Service d'Hépato-Gastroentérologie, Hôpital de la Cavale Blanche, Brest, France

1 Service d'Hépato-Gastroentérologie et de Nutrition,Centre Hospitalier Laënnec, France

[1] Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD. Liver biopsy. Hepa‐

[2] Dhumeaux D, Marcellin P, Lerebours E. Treatment of hepatitis C. The 2002 French

[3] Imbert-Bismut F, Ratziu V, Pieroni L, Charlotte F, Benhamou Y, Poynard T. Biochem‐ ical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective

[4] Leroy V, Hilleret MN, Sturm N, Trocme C, Renversez JC, Faure P, et al. Prospective comparison of six non-invasive scores for the diagnosis of liver fibrosis in chronic

**7. Conclusion**

**Author details**

**References**

Jean-François Cadranel1

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

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

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

The incapacity to detect the liver by percussion or ultrasound is an absolute contraindication to performing transparietal liver biopsy, as is suspicion of hydatid cyst.

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

Dilatation of the extrahepatic bile ducts and cholangitis are contraindications to transparie‐ tal liver biopsy [1].

#### **5.5. Relative contraindications**

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 deficits in hemostasis [1, 30].
