Complications of Ultrasound-guided Liver Biopsy at a Tertiary Care Hospital in Pakistan: An Audit

Abstract

Introduction Liver diseases account for two million deaths per year worldwide, half of which are attributed to complications of cirrhosis. Liver conditions have wide-ranging serological findings and imaging appearances and may require biopsy for a definitive diagnosis. Despite ultrasound (US) guidance, liver biopsy is an invasive procedure and the expected benefit must outweigh risks involved. Objective  The purpose of the audit was to calculate complication rates of US-guided liver biopsy and summarize institutional data pertaining to the procedure.  Materials and Methods The audit was performed at Aga Khan University Hospital, Karachi, Pakistan. All consecutive patients undergoing liver biopsy from February 2017 - February 2018 were included. Medical records of patients were reviewed for complications of liver biopsy.  Results The study population consisted of 157 adult and 21 pediatric patients. Complications were encountered in nine patients (5%), minor complications in seven (4%) and major complications in two (1.1%). Among the minor complications, haematoma formation was noted in four patients (2.2%), minor abdominal pain in two patients (1.1%), and minor hemorrhage during the procedure in one patient (0.5%). Minor complications were seen more frequently in pediatric (14%) patients as compared to adults (3.8%). One patient developed a major hemorrhage (> 2 g/dl drop in hemoglobin (Hb)), and another patient developed severe vasovagal hypotension. There was no mortality in the study population resulting from complications of the liver biopsy. The audit standards set were met for all parameters, except major hemorrhage (< 0.5%) which was narrowly missed (0.56%). Conclusion US-guided liver biopsy at our institution has a good safety profile with complication rates within the expected range. Departmental practices are compliant with established practices and guidelines.