**4. Optimal methods for carrying out lb in 2012**

Methods for performing LB will not be detailed here, but are available in practical guide‐ lines [30]. Several issues will be addressed:

When all conditions are met, then "ambulatory" liver biopsy may be performed [30]. In the study published in 2000 (completed in 1997) [31], 27% of liver biopsies were performed on an outpatient basis, most often for chronic hepatitis C; this figure is currently at 45% [13]. Several French teams have shown that outpatient liver biopsy is a safe and effective proce‐ dure and that liver biopsy performed on an outpatient basis reduces discomfort and increas‐ es the acceptability of subsequent examination conducted under the same conditions. If all conditions are not met and/or if organizational arrangements do not permit it, then liver bi‐ opsy should be performed via traditional hospitalization.

LB is carried out by hepatogastroenterologists, radiologists and occasionally by surgeons. Currently, liver biopsy is performed in France by a hepatogastroenterologist in 63.5% of cas‐ es, by a radiologist in 34.8% of cases and by a surgeon in 1.7% of cases [13]. The increasing number of liver biopsies performed by radiologists in France is linked to an increased num‐ ber of biopsies performed using ultrasound guidance or guided real-time ultrasonography [30] and by the development of the transvenous route as compared to the transparietal route. Indeed, in 1997, 9% of liver biopsies were performed via the transvenous route com‐ pared to 22.4% in 2009 [13]. In the US, 50% of biopsies are performed by radiologists. In that country, it is felt that the number of LB performed in order to gain sufficient expertise is at least 40, carried out in the presence of an experienced radiologist [1].
