title: Ultrasound-assisted percutaneous liver biopsy performed by a physician assistant.
abstract: OBJECTIVE
  Percutaneous liver biopsy is an essential diagnostic tool utilized in the management of patients with liver disease. This procedure is generally performed by a physician and has a small but well-defined complication rate. We report on the complication rate and efficiency of ultrasound-assisted percutaneous liver biopsy performed by an experienced physician assistant.
  
  
  METHODS
  One thousand eighty-six consecutive outpatient liver biopsies (847 hepatic allografts and 239 native livers) were performed at a single center by a physician assistant between June, 1996 and June, 2000. Patients with hepatic mass lesions, unusual hepatic anatomy, and uncorrectable coagulopathy (international normalized ratio > 1.7, platelet count < 50 x 10(9)/L) were excluded. Bedside ultrasonography was used to determine the optimal site for the liver biopsy. Liver biopsies were performed with a 15-gauge Jamshidi aspiration biopsy needle. Patients were observed for 3 h after biopsy, followed by dismissal with subsequent contact in 24 h to assess outcome and complications.
  
  
  RESULTS
  Adequate tissue was obtained in 1084 cases (99.8%), with a mean tissue length of 3.2 cm. After the procedure, narcotic analgesia was necessary in 116 (10%) of the patients undergoing liver biopsies. The overall complication rate requiring hospitalization was 0.6%. Major complications requiring intervention occurred in four patients (0.4%). There were no deaths resulting from liver biopsies.
  
  
  CONCLUSIONS
  We conclude that outpatient percutaneous liver biopsy can be safely and effectively performed by a trained physician assistant.
authors.affiliation: Transplant Center, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Gunneson
authors.forename: K V Narayanan
authors.initials: KV
authors.lastname: Menon
authors.forename: Russell H
authors.initials: RH
authors.lastname: Wiesner
authors.forename: Judith A
authors.initials: JA
authors.lastname: Daniels
authors.forename: J Eileen
authors.initials: JE
authors.lastname: Hay
authors.forename: Michael R
authors.initials: MR
authors.lastname: Charlton
authors.forename: David J
authors.initials: DJ
authors.lastname: Brandhagen
authors.forename: Charles B
authors.initials: CB
authors.lastname: Rosen
authors.forename: Michael K
authors.initials: MK
authors.lastname: Porayko
mesh_terms: D001706:Biopsy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010823:Physician Assistants; D011446:Prospective Studies; D014463:Ultrasonography