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


METHODS
We 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.


RESULTS
Macroscopic 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.


CONCLUSIONS
Mini-laparoscopy with guided liver biopsy allows reliable and safe evaluation of liver disease in patients with severe coagulopathy.
First Department of Medicine, Johannes Gutenberg-University, Mainz, Germany.
Ulrike
U
Denzer
Ilka
I
Helmreich-Becker
Peter R
PR
Galle
Ansgar W
AW
Lohse
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D001778:Blood Coagulation Disorders / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D020706:Laparoscopes / Q000009:adverse effects*; D010535:Laparoscopy / Q000009:adverse effects*; D008107:Liver Diseases / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results