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Multiple biopsy passes and the risk of complications of percutaneous liver biopsy

Chi, Heng; Hansen, Bettina E.; Tang, Wing Yin; Schouten, Jeoffrey N.L.; Sprengers, Dave; Taimr, Pavel; Janssen, Harry L.A.; de Knegt, Robert J.

European Journal of Gastroenterology & Hepatology: January 2017 - Volume 29 - Issue 1 - p 36–41
doi: 10.1097/MEG.0000000000000731
Original Articles: Liver Histology

Background and aim To minimize the sample variability of liver biopsy, the tissue length should be at least 25 mm. Consequently, more than one biopsy pass is needed with cutting biopsy needles. We aimed to investigate the risk factors of biopsy-related complication, including the number of biopsy passes.

Methods All consecutive liver biopsies performed between 2005 and 2014 were included. Biopsies were ultrasound assisted and performed with cutting biopsy needles. A complication was an event where the patient visited a healthcare provider because of biopsy-related complaints. Complications followed by hospitalization 2 or more days or intervention were considered severe.

Results In total, 1806 liver biopsies were analyzed. Overall, 102 (5.6%) complications were observed, of which 31 (1.7%) were severe. One (0.06%) patient died. Common complications were pain (n=75/102; 74%) and bleeding (n=34/102; 33%). Two biopsy passes were not associated with an increased risk of complications compared with one biopsy pass [odds ratio (OR): 1.59; 95% confidence interval (CI): 0.83–3.04; P=0.16], whereas three or more biopsy passes increased this risk compared with one (OR: 2.97; 95% CI: 1.38–6.42; P=0.005) or two biopsy passes (OR: 1.87; 95% CI: 1.10–3.19; P=0.021). The risk of severe complications was not influenced by the number of biopsy passes (P>0.24). Hepatic malignancy (OR: 3.21; 95% CI: 1.18–8.73; P=0.022) and international normalized ratio 1.4 or more (OR: 7.03; 95% CI: 2.74–18.08; P<0.001) were risk factors of severe complications.

Conclusion Severe complication rate and mortality were low. Performing multiple biopsy passes was not associated with severe complications, whereas hepatic malignancy or elevated international normalized ratio were associated with an increased risk.

aDepartment of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands

bDepartment of Gastroenterology and Hepatology, AZ Nikolaas, Sint-Niklaas, Belgium

cToronto Centre for Liver Disease, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada

Correspondence to Robert J. de Knegt, MD, PhD, Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Room Ha-203, ’s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands Tel: +31 10 703 5942; fax: +31 10 436 5916; e-mail:

Received May 29, 2016

Accepted July 18, 2016

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