Z Gastroenterol 2005; 43 - P449
DOI: 10.1055/s-2005-920238

Prospective randomised comparison of mini-Laparoscopy and percutaneous liver biopsy. Analysis of 1000 examinations

UW Denzer 1, A Arnoldy 2, U Weickert 3, S Kanzler 4, PR Galle 4, JR Riemann 5, HP Dienes 6, AW Lohse 7
  • 1Abteilung für Gastroenterologie, Hamburg, Deutschland
  • 2I. Medizinische Klinik Johannes Gutenberg Universität Mainz, Mainz
  • 3Medizinische Klinik C, Klinikum der Stadt Ludwigshafen, Ludwigshafen
  • 4I. Medizinische Klinik und Poliklinik, Johannes Gutenberg-Universität Mainz, Mainz
  • 5Medizinische Klinik C, Klinikum der Stadt Ludwigshafen, Ludwigshafen
  • 6Institut für Pathologie, Universität zu Köln, Köln
  • 7Medizinische Klinik I, Universitätsklinikum Hamburg-Eppendorf, Hamburg

Introduction: Percutaneous liver biopsy is the gold standard for gaining liver histology in chronic liver disease (pLB). Nevertheless false negative biopsy rates in cirrhosis range from 10–50%. Diagnostic mini-laparoscopy (optic 1.9mm) under conscious sedation (ML) has the advantage of additional macroscopic evaluation. This study compared both methods prospectively and randomised. Methods: Patients gave written informed consent. Exclusion of severe coagulation disorders. Liver biopsy: Vim Silverman needle (ML); Menghini needle (pLB) (biopsy diameter 1.4mm). Macroscopic liver evaluation documented as normal, fibrosis /irregular cirrhosis and cirrhosis. Formalin fixed paraffin embedded sections stained with H&E and IVG. Slides were blindly coded and graded (HAI score). Controls day 1 after biopsy: Blood count and ultrasound. Results: Patients: 1000 patients were randomised (9/00–7/04), study drop out: 75. Table 1 shows clinical characteristics of patients. Diagnosis of cirrhosis: Criteria for cirrhosis: PLB: HAI score 5 or 6; ML: Combination of macroscopic (irregular cirrhosis scored as fibrosis) and histologic scoring. Available for blinded histologic scoring: pLB in 410 cases, ML in 401 cases. No sign. difference in length of biopsy specimen, marg. difference in count of portal fields (table 2). Comparison of blindly coded histologic grading revealed no sign. differences: Liver cirrhosis was diagnosed in pLB in 23.0% (n=94) compared to ML in 25.3% (n=103) p=0.34. Comparison of histologic staging in pLB and combined macroscopic /histologic staging in ML resulted in a significant higher rate of 10% more frequently diagnosed liver cirrhoses with ML procedure (fig.1). pLB diagnosed liver cirrhosis in 22.9% (n=94) compared to ML in 33.2% (n=133) (p=0.001).

Complications: PLB: Severe (requiring hospital stay longer than one day): 0.9% (Hemobilia: 1; post biopsy bleeding: 3). ML: 0.2% (Hemobilia: 1) p=0.188 ns. (table 3). Control day 1 post biopsy: No sign. differences in ultrasound evaluation and marg. difference in Hb difference to baseline (table 2).

Conclusion: Mini-laparoscopic evaluation diagnoses of about 10% more liver cirrhoses. Mini-laparoscopic liver biopsy is shown to be safe and superior in staging of liver diseases.

Keywords: Liver biopsy, complications, liver cirrhosis, mini-laparoscopy, percutaneous liver biopsy