Complication Rate of Percutaneous Liver Biopsies Among Persons With Advanced Chronic Liver Disease in the HALT-C Trial

Leonard B. Seeff, Gregory T. Everson, Timothy R. Morgan, Teresa M. Curto, William M. Lee, Marc G. Ghany, Mitchell L. Shiffman, Robert J. Fontana, Adrian M. Di Bisceglie, Herbert L. Bonkovsky, Jules L. Dienstag

Research output: Contribution to journalArticle

181 Citations (Scopus)

Abstract

Background & Aims: Although percutaneous liver biopsy is a standard diagnostic procedure, it has drawbacks, including risk of serious complications. It is not known whether persons with advanced chronic liver disease have a greater risk of complications from liver biopsy than patients with more mild, chronic liver disease. The safety and complications of liver biopsy were examined in patients with hepatitis C-related bridging fibrosis or cirrhosis who were enrolled in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis trial. Methods: Standard case report forms from 2740 liver biopsies performed at 10 study sites between 2000 and 2006 were reviewed for serious adverse events, together with information from questionnaires completed by investigators about details of biopsy techniques used at each hospital. Results: There were 29 serious adverse events (1.1%); the most common was bleeding (16 cases; 0.6%). There were no biopsy-related deaths. The bleeding rate was higher among patients with platelet counts of 60,000/mm3 or less and among those with an international normalized ratio of 1.3 or greater, although none of the patients with an international normalized ratio greater than 1.5 bled. Excluding subjects with a platelet count of 60,000/mm3 or less would have reduced the bleeding rate by 25% (4 of 16), eliminating only 2.8% (77 of 2740) of biopsies. Operator experience, the type of needle used, or the performance of the biopsy under ultrasound guidance did not influence the frequencies of adverse events. Conclusions: Approximately 0.5% of persons with hepatitis C and advanced fibrosis experienced potentially serious bleeding after liver biopsy; risk increased significantly in patients with platelet counts of 60,000/mm3 or less.

Original languageEnglish (US)
Pages (from-to)877-883
Number of pages7
JournalClinical Gastroenterology and Hepatology
Volume8
Issue number10
DOIs
StatePublished - Oct 2010

Fingerprint

Liver Diseases
Chronic Disease
Biopsy
Liver
Fibrosis
Hepatitis C
Platelet Count
Hemorrhage
International Normalized Ratio
Needles
Antiviral Agents
Research Personnel
Safety

Keywords

  • Adverse Event
  • Bleeding
  • Complications
  • INR
  • Liver Biopsy
  • Platelet Count
  • Serious Adverse Events

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Complication Rate of Percutaneous Liver Biopsies Among Persons With Advanced Chronic Liver Disease in the HALT-C Trial. / Seeff, Leonard B.; Everson, Gregory T.; Morgan, Timothy R.; Curto, Teresa M.; Lee, William M.; Ghany, Marc G.; Shiffman, Mitchell L.; Fontana, Robert J.; Di Bisceglie, Adrian M.; Bonkovsky, Herbert L.; Dienstag, Jules L.

In: Clinical Gastroenterology and Hepatology, Vol. 8, No. 10, 10.2010, p. 877-883.

Research output: Contribution to journalArticle

Seeff, LB, Everson, GT, Morgan, TR, Curto, TM, Lee, WM, Ghany, MG, Shiffman, ML, Fontana, RJ, Di Bisceglie, AM, Bonkovsky, HL & Dienstag, JL 2010, 'Complication Rate of Percutaneous Liver Biopsies Among Persons With Advanced Chronic Liver Disease in the HALT-C Trial', Clinical Gastroenterology and Hepatology, vol. 8, no. 10, pp. 877-883. https://doi.org/10.1016/j.cgh.2010.03.025
Seeff, Leonard B. ; Everson, Gregory T. ; Morgan, Timothy R. ; Curto, Teresa M. ; Lee, William M. ; Ghany, Marc G. ; Shiffman, Mitchell L. ; Fontana, Robert J. ; Di Bisceglie, Adrian M. ; Bonkovsky, Herbert L. ; Dienstag, Jules L. / Complication Rate of Percutaneous Liver Biopsies Among Persons With Advanced Chronic Liver Disease in the HALT-C Trial. In: Clinical Gastroenterology and Hepatology. 2010 ; Vol. 8, No. 10. pp. 877-883.
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abstract = "Background & Aims: Although percutaneous liver biopsy is a standard diagnostic procedure, it has drawbacks, including risk of serious complications. It is not known whether persons with advanced chronic liver disease have a greater risk of complications from liver biopsy than patients with more mild, chronic liver disease. The safety and complications of liver biopsy were examined in patients with hepatitis C-related bridging fibrosis or cirrhosis who were enrolled in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis trial. Methods: Standard case report forms from 2740 liver biopsies performed at 10 study sites between 2000 and 2006 were reviewed for serious adverse events, together with information from questionnaires completed by investigators about details of biopsy techniques used at each hospital. Results: There were 29 serious adverse events (1.1{\%}); the most common was bleeding (16 cases; 0.6{\%}). There were no biopsy-related deaths. The bleeding rate was higher among patients with platelet counts of 60,000/mm3 or less and among those with an international normalized ratio of 1.3 or greater, although none of the patients with an international normalized ratio greater than 1.5 bled. Excluding subjects with a platelet count of 60,000/mm3 or less would have reduced the bleeding rate by 25{\%} (4 of 16), eliminating only 2.8{\%} (77 of 2740) of biopsies. Operator experience, the type of needle used, or the performance of the biopsy under ultrasound guidance did not influence the frequencies of adverse events. Conclusions: Approximately 0.5{\%} of persons with hepatitis C and advanced fibrosis experienced potentially serious bleeding after liver biopsy; risk increased significantly in patients with platelet counts of 60,000/mm3 or less.",
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AU - Curto, Teresa M.

AU - Lee, William M.

AU - Ghany, Marc G.

AU - Shiffman, Mitchell L.

AU - Fontana, Robert J.

AU - Di Bisceglie, Adrian M.

AU - Bonkovsky, Herbert L.

AU - Dienstag, Jules L.

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N2 - Background & Aims: Although percutaneous liver biopsy is a standard diagnostic procedure, it has drawbacks, including risk of serious complications. It is not known whether persons with advanced chronic liver disease have a greater risk of complications from liver biopsy than patients with more mild, chronic liver disease. The safety and complications of liver biopsy were examined in patients with hepatitis C-related bridging fibrosis or cirrhosis who were enrolled in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis trial. Methods: Standard case report forms from 2740 liver biopsies performed at 10 study sites between 2000 and 2006 were reviewed for serious adverse events, together with information from questionnaires completed by investigators about details of biopsy techniques used at each hospital. Results: There were 29 serious adverse events (1.1%); the most common was bleeding (16 cases; 0.6%). There were no biopsy-related deaths. The bleeding rate was higher among patients with platelet counts of 60,000/mm3 or less and among those with an international normalized ratio of 1.3 or greater, although none of the patients with an international normalized ratio greater than 1.5 bled. Excluding subjects with a platelet count of 60,000/mm3 or less would have reduced the bleeding rate by 25% (4 of 16), eliminating only 2.8% (77 of 2740) of biopsies. Operator experience, the type of needle used, or the performance of the biopsy under ultrasound guidance did not influence the frequencies of adverse events. Conclusions: Approximately 0.5% of persons with hepatitis C and advanced fibrosis experienced potentially serious bleeding after liver biopsy; risk increased significantly in patients with platelet counts of 60,000/mm3 or less.

AB - Background & Aims: Although percutaneous liver biopsy is a standard diagnostic procedure, it has drawbacks, including risk of serious complications. It is not known whether persons with advanced chronic liver disease have a greater risk of complications from liver biopsy than patients with more mild, chronic liver disease. The safety and complications of liver biopsy were examined in patients with hepatitis C-related bridging fibrosis or cirrhosis who were enrolled in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis trial. Methods: Standard case report forms from 2740 liver biopsies performed at 10 study sites between 2000 and 2006 were reviewed for serious adverse events, together with information from questionnaires completed by investigators about details of biopsy techniques used at each hospital. Results: There were 29 serious adverse events (1.1%); the most common was bleeding (16 cases; 0.6%). There were no biopsy-related deaths. The bleeding rate was higher among patients with platelet counts of 60,000/mm3 or less and among those with an international normalized ratio of 1.3 or greater, although none of the patients with an international normalized ratio greater than 1.5 bled. Excluding subjects with a platelet count of 60,000/mm3 or less would have reduced the bleeding rate by 25% (4 of 16), eliminating only 2.8% (77 of 2740) of biopsies. Operator experience, the type of needle used, or the performance of the biopsy under ultrasound guidance did not influence the frequencies of adverse events. Conclusions: Approximately 0.5% of persons with hepatitis C and advanced fibrosis experienced potentially serious bleeding after liver biopsy; risk increased significantly in patients with platelet counts of 60,000/mm3 or less.

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KW - Complications

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