Nadim Iqbal Sheikh, Syed Irfan Ahmed, Saira Zaheer, Syeda Arzinda Fatima.
Evaluation of Liver Biopsy as a safe procedure carried out in day surgery setting
J Rawal Med Coll Dec 2004;8(2):69-71.
Department of Medicine, Holy Family Hospital and Rawalpindi Medical College, Rawalpindi

Background: To evaluate characteristics of patients undergoing liver biopsy on outpatient basis in a day care setting and to evaluate the outcome of the procedure. Methods: Fifty patients (28 males and 22 females) undergoing liver biopsy were prospectively enrolled for the study from 1998-2003, conducted in the Department of Medicine, Holy Family Hospital, Rawalpindi. The indications included evaluation of patients for chronic hepatitis before interferon plus ribavirin therapy, pyrexia of unknown origin, patients on methotrexate therapy for rheumatoid arthritis and suspected abdominal tuberculosis or lymphoma. Liver biopsy was carried out in the morning hours, using modified `Menghini needle (size 16G, 11 mm length) as described by Sherlock (subcostal method). Only patients residing within 10 miles of the centre were enrolled, unless they were able to spend a night with friends or family within Rawalpindi area iii case of need. Results: The youngest patient included in the study was aged 18 years and being investigated for pyrexia of unknown origin (PUO) while the eldest was 52 years old. Average age of patients was 37.6 years. In a total of 50 patients, 37 (74%) were undergoing evaluation prior to having ribavirin and interferon therapy. In them, a semiquantitative assessment of inflammation (grading) and fibrosis (progression) (Knodell score) was evaluated. There were eleven patients with PUO and in four of them, a positive liver biopsy helped in establishing the diagnosis of tuberculosis while in two, lymphoma was diagnosed. In two patients, the results of liver biopsy helped in making informed decision about discontiniung methotrexate for rheumatoid arthritis. The mean stay in the unit was six hours. The shortest was five hours and the longest stay was nine hours. All 50 patients tolerated the procedure well. The complications were minor and included local pain and referred pain, at the tip of right shoulder. There were no major complications and no transfusions were reqiured. All patients complained of pain/ache at the biopsy site, with 33 (66%) experiencing pain and 17 (34%) complaining of ache at the site. Referred pain at the tip of right shoulder was felt by 31 (62%) patients while 8 (16%) had a feeling of nausea and 4 (8%) felt transient epigastric discomfort immediately after the procedure. Conclusion: Outpatient liver biopsy is a safe option in selected patients with a good outcome and negligible complications.

Category: Internal Medicine
Keywords: Liver Biopsy. Hepatitis. Liver. Biopsy.

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