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Presse Med 1997 Mar 1;26(6):260-261
Hepatic puncture biopsy in ambulatory care. Advantages and
disadvantages.
[Article in French]
Nouel O
There is a clear trend towards favoring outpatient care in an attempt to control
health care costs. Despite widespread acceptance in some countries, many teams
in France still prefer to hospitalize patients requiring percutaneous liver
biopsy because the outpatient setting has not been encouraged in French text
books on hepatology, many gastroenterologists do not have access to outpatient
facilities, and the lack of French references which has raised questions as
to the legal responsibilities involved. The series of 231 outpatient percutaneous
liver biopsies reported by Bourgaux in this issue of La Presse Medicale will
remove the doubt in many minds. There are many advantages for the generally
young population with early stage liver disease, frequently Hepatitis C, requiring
percutaneous liver biopsy. Lower cost is probably the primary advantage, but
improved patient comfort, especially if repeated procedures are needed, is also
greatly appreciated. The outpatient procedure is safe when all the selection
criteria are met including: normal coagulation, ultrasonographically homogeneous
liver, patient compliance and availability of a structured outpatient clinic,
and absence of a severe concomitent disease. These apparently restrictive criteria
actually include the majority of the indications for liver biopsy. There is
another debate on whether echo-guided biopsy would be even safer but as emphasized
by Bourgaux et al. this would require a reorganization of most of the hepatogastroenterology
departments. One other point cannot be overlooked. Some operators (and patients)
may also feel that the impressive nature of the procedure merits a more impressive
setting, i.e. full hospitalization. Consequently, while it is quite reasonable
to propose outpatient liver biopsy as a classical procedure, there are situations
when personal preference may still dictate hospitalization.
PMID: 9122121, UI: 97252887
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