title: Percutaneous liver biopsy practice patterns among Canadian hepatologists.
abstract: BACKGROUND
  Percutaneous liver biopsy (PLB) is the standard procedure to obtain histological samples essential for the management of various liver diseases. While safe, many hepatologists no longer perform their own PLBs; the reasons for this practice shift are unknown.
  
  
  OBJECTIVE
  To describe the attitudes, practice patterns and barriers to PLB among hepatologists in Canada.
  
  
  METHODS
  A survey was distributed to all hepatologists in Canada.
  
  
  RESULTS
  Thirty-two of 40 (80%) hepatologists completed the survey; the majority of respondents were male (72%) and had been in practice for >5 years in an academic setting. Fifty-six per cent of hepatologists referred all PLBs to radiology, and only 19% of hepatologists reported performing their own PLBs most or all of the time. There were no sex differences nor were there differences based on years in practice. Fifty per cent of respondents who performed PLB routinely used ultrasound, and PLBs are performed in equal frequency in an ambulatory procedure area (50%) versus the endoscopy suite (36%). For almost one-half of hepatologists (47%), their performance of PLBs decreased in the past five years. The majority of respondents at an academic centre (75%) reported access to FibroScan (Echosens, France), and most estimated a resultant 25% to 50% reduction in the need for PLBs. Lack of resources, patient preference and suboptimal reimbursement were the most common reasons cited for not performing PLBs.
  
  
  CONCLUSIONS
  Most hepatologists in Canada do not perform PLBs to the extent that they did in the past, but refer to radiology. The reasons for this shift in practice include lack of resources, improved perception of safety and patient preference. Where available, FibroScan resulted in a perceived 25% to 50% reduction in required liver biopsies.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Aljawad
authors.forename: Eric M
authors.initials: EM
authors.lastname: Yoshida
authors.forename: Julia
authors.initials: J
authors.lastname: Uhanova
authors.forename: Paul
authors.initials: P
authors.lastname: Marotta
authors.forename: Natasha
authors.initials: N
authors.lastname: Chandok
mesh_terms: D001291:Attitude of Health Personnel; D001707:Biopsy, Needle / Q000379:methods*; D002170:Canada; D004724:Endoscopy / Q000379:methods; D005260:Female; D005762:Gastroenterology / Q000379:methods; D019538:Health Care Surveys; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis*; D008297:Male; D057240:Patient Preference; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012051:Reimbursement Mechanisms