title: Major changes in the number and indications of liver biopsy for chronic liver diseases over one decade in France.
abstract: OBJECTIVE
  French clinical practice guidelines on the use of liver biopsy (LB) published in 2002 focused on ultrasound guidance (USG) and ambulatory LB. The aims of this study were as follows: (i) to evaluate the number and indications for LB for chronic liver diseases and (ii) to evaluate LB modalities according to French clinical practice guidelines. Data recorded included the number and indications for LB, procedures, use of USG, and complications.
  
  
  RESULTS
  A total of 131 centers participated: 8741 LB were performed versus 12 000 in 1997; ambulatory LB was performed in 48.6% of cases (vs. 27% in 1997; P<0.001). USG during LB was used in 89.7% of the centers, among which 42 (31.8%) used real-time USG (vs. 56 and 22%, respectively, in 1997; P<0.01). The main indications for LB were chronic hepatitis C in 24.6% of cases (vs. 54.1% in 1997; P<0.001), and viral B or B-delta in 15.0% (vs. 5.8%; P<0.001). Severe complications were less frequent at centers with systematical USG during LB than at those without such guidance (P<0.01).
  
  
  CONCLUSIONS
  In this large nationwide study, major trends were as follows: (i) a marked decrease in LB number, related to a decrease in LB for chronic viral hepatitis C; (ii) increased use of USG; and (iii) an increase in the number of ambulatory LB. Severe complications decreased significantly at centers in which USG was systematically applied.
authors.affiliation: aDepartment of Hepato-Gastroenterology, Alcohology and Nutrition, Laennec Hospital, Creil bDepartment of Hepato-Gastroenterology cClinical Investigation Center INSERM 1412, University Hospital La Cavale Blanche, Brest dHepato-Gastroenterology Office, Montpellier eANGH: French Association of Hepato-Gastroenterologists of Primary Referral Hospitals, Montfermeil fAFEF: French Association for the Study of the Liver gCREGG: French Association of Private Gastroenterology, Poitiers, France.
authors.forename: Jean-François D
authors.initials: JF
authors.lastname: Cadranel
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Nousbaum
authors.forename: Maelenn
authors.initials: M
authors.lastname: Gouillou
authors.forename: Bertrand
authors.initials: B
authors.lastname: Hanslik
mesh_terms: D001706:Biopsy / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends*; D002908:Chronic Disease; D005602:France; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D061705:Image-Guided Biopsy / Q000639:trends; D008099:Liver / Q000473:pathology*; D008107:Liver Diseases / Q000175:diagnosis* / Q000473:pathology; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D018084:Ultrasonography, Interventional / Q000639:trends