Liver assessment and biopsy in patients with marked coagulopathy: value of mini-laparoscopy and control of bleeding

Denzer, Ulrike; Helmreich-Becker, Ilka; Galle, Peter R.; Lohse, Ansgar W.
April 2003
American Journal of Gastroenterology;Apr2003, Vol. 98 Issue 4, p893
Academic Journal
: ObjectivesEvaluation of liver disease in patients with a high risk of postbiopsy bleeding presents a diagnostic challenge. Mini-laparoscopy offers the possibility of coagulation of biopsy site and the additional advantage of macroscopic liver assessment. We wished to assess the value and safety of mini-laparoscopy with guided biopsy as a diagnostic approach in patients in whom percutaneous liver biopsy is considered contraindicated because of a marked coagulopathy.: MethodsWe investigated 61 consecutive patients with marked coagulopathy (prolonged international normalized ratio > 1.5, thrombocytopenia < 50/nl, or both; von Willebrand’s disease/hemophilia). Diagnostic mini-laparoscopy with visually guided liver biopsy was undertaken for the evaluation of liver disease. Biopsy sites were coagulated prophylactically (n = 4) or therapeutically (n = 52). Safety, diagnostic yield, and therapeutic consequences were assessed.: ResultsMacroscopic assessment of the liver was possible in 60/61 high-risk patients and was considered diagnostic in 1/61. In 58 of the remaining 60 patients, liver biopsy was technically feasible. There was no persistent postbiopsy bleeding. One patient with fulminant hepatic failure had self-limiting bleeding from the abdominal wall. Ninety-seven percent of the biopsies were of adequate size for diagnostic histological evaluation.: ConclusionsMini-laparoscopy with guided liver biopsy allows reliable and safe evaluation of liver disease in patients with severe coagulopathy.


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