Endoscopy 2003; 35(12): 1080
DOI: 10.1055/s-2003-44605-2
Letter to the Editor
© Georg Thieme Verlag Stuttgart · New York

Reply to Orlando and Lirussi

I.  Helmreich-Becker1
  • 1Gastroenterological Practice, Wiesbaden, Germany
Further Information

Publication History

Publication Date:
29 April 2004 (online)

The letter from Orlando and Lirussi makes the important point that laparoscopy combined with liver biopsy improves the diagnosis of cirrhosis. In their review of 1003 patients undergoing conventional laparoscopy combined with liver biopsy, a positive diagnosis of cirrhosis was confirmed by at least one or both procedures in 42 % (411 of 981) of patients and confirmed by histology alone in only 33 % (324 of 981) [1].

I agree with Orlando and Lirussi that a relatively high percentage of inadequate biopsies were noted in our patients and that this may have been associated with the biopsy technique using a 1.8-mm Silverman needle. We now also carry out liver biopsies using a disposable Tru-Cut needle and have not had a substantial rate of inadequate biopsies. It can also be assumed that our group was going through a learning curve in handling the Silverman needle during the early investigations.

The relatively high percentage of macroscopically diagnosed cirrhosis is due to the selection of patients, since all high-risk patients with advanced cirrhosis with low platelets and an international normalized ratio (INR) > 1.5 were scheduled for minilaparoscopy-guided liver biopsy rather than percutaneous liver biopsy. One of the main problems addressed by Manns [2] and Orlando and Lirussi [1] is the fact that there are as yet no standardized criteria for definitive macroscopic diagnosis of cirrhosis. In reference to the letter by Orlando and Lirussi, intra-abdominal signs of portal hypertension - i. e., dilated vessels in the falciform ligament and in the peritoneal wall - were also included in the evaluation of cirrhosis and noted in the written description of the minilaparoscopic findings. Not all patients underwent gastroscopy for the detection of esophageal varices.

The response by Orlando and Lirussi points out that laparoscopy combined with liver biopsy is still the most reliable procedure for diagnosing liver cirrhosis. Due to the minimal invasiveness of the minilaparoscopic technique, it is currently also a safe and improved method of diagnosis.

References

  • 1 Orlando R, Lirussi F, Okolicsanyi L. Laparoscopy and liver biopsy - further evidence that the two procedures improve the diagnosis of liver cirrhosis: a retrospective study of 1003 consecutive examinations.  J Clin Gastroenterol. 1990;  12 47-52
  • 2 Manns M P, Schneider A, Meier P N. Minilaparoscopy for early diagnosis of cirrhosis: is the endoscopist’s eye better than the histopathologist’s?.  Endoscopy. 2003;  35 74-75

I. Helmreich-Becker, M.D. 

Gastroenterological Clinic

Von Leyden Strasse 23 a
65191 Wiesbaden
Germany

Fax: +49-0611-39934

Email: helmreich-becker.pge@dkd-wiesbaden.de

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