• Patient experience of day case liver biopsy: Prospective audit

      Li, Ka Kit; Mortimore, Gerri; Jackson, Michelle; Clarke, Dominic; Freeman, Jan G.; Austin, Andrew; Royal Derby Hospital (Wiley, 2006-10-01)
      Background: Percutaneous liver biopsy remains an important toolin the diagnosis and staging of chronic liver disease. There is oftenreluctance to use wider bore needles because of potentially highercomplication rates. There are no good prospective studies of thepatient experience and morbidity associated with the procedure.Aims: To describe the patient experience and compare two differ-ent biopsy needles. Patients and Methods: Data collected prospec-tively was available for 83 ultrasound-sited percutaneous biopsiesfor chronic liver disease. Subjects were regularly offered analgesiaand asked to rate pain on a visual analogue scale (0-10). Patientswere contacted 30 days post-biopsy. Results: Indications for bi-opsy were alcoholic liver disease (21%), NAFLD (21%), HCV(14%), HBV (8%), haemachromatosis (10%), autoimmune hepatitis(8%), other (22%). Data are expressed as mean (CI) and comparedusing t-test and ANOVA. Within the first 6 hours, 28 took parac-etamol only, 8 required codeine-based analgesia, and 1 receivedpethidine. There were no episodes of bradycardia, hypotension orpyrexia and only one re-admission (for recurrent ascites). Therewere no serious adverse events in either group. Conclusions: Themajority of patients experienced only mild discomfort after liverbiopsy and 45% did not require analgesia. A small difference inpain scores was detected at one hour but did not persist to sixhours and may reflect the greater use of lignocaine by one group.
    • Prospective audit of liver biopsy practice: Is bigger better?

      Li, Ka Kit; Mortimore, Gerri; Jackson, Michelle; Semeraro, David; Clarke, Dominic; Freeman, Jan G.; Austin, Andrew; Royal Derby Hospital (Wiley, 2006-10)
      Background: Percutaneous liver biopsy remains an important toolin the diagnosis and staging of chronic liver disease. For reliableand reproducible interpretation, a specimen containing a minimum of six portal tracts and ideally more than ten is required.There is often reluctance to use wider bore needles because ofpotentially higher complication rates. Aims: To compare the ad-equacy of samples obtained using two different biopsy needles.Patients and Methods: Data was collected prospectively for 128ultrasound-sited percutaneous biopsies for chronic liver diseaseover a 10 month period using a proforma. Results: Indications forbiopsy were alcoholic liver disease (21%), NAFLD (21%), HCV(14%), HBV (8%), haemachromatosis (10%), autoimmune hepatitis(8%), other (22%). There were no serious adverse events in eithergroup. Biopsy characteristics are compared in Table 1. Data areexpressed as mean (CI) or median (range) and compared using ttest, Mann-Whitney U test or Chi-squared. Conclusions: Liverbiopsy samples obtained with a 15G Menghini needle are superiorto those obtained using an 18G Trucut needle. The latter are ofteninadequate for assessment using accepted criteria.