Post-procedure surveillance in liver biopsy: How long is long enough?

Aim: To assess the incidence of complications following liver biopsy and the impact of pre-procedural pethidine on complications and analgesia administration. Method: A retrospective audit of percutaneous liver biopsies undertaken at Dunedin Public Hospital (2001-2006). Patients' medical files were consulted for demographics, biopsy indication, complications, frequency, and timing of analgesia. Results: 447 biopsies were analysed. Primary indications included: hepatitis C (38.8%), abnormal liver function tests (18.3%), methotrexate therapy (12.5%), and malignancy (10.3%). 303 (68%) biopsies resulted in no complications. Major complications were not experienced. Minor complications included: pain (32.2%), hypotension (1.3%), nausea/ vomiting (0.9%), and alcohol withdrawal (0.2%). More females (47%) than males (31%) reported complications. Post-procedural analgesia was administered in 31% of biopsies; only 9% required analgesia more than 2 hours after biopsy. Patients who had pre-procedural pethidine experienced similar rates of complications as patients not receiving pre-procedural pethidine, but received less post-procedural opiate analgesia. Conclusion: No major complications occurred, whilst the rate of minor complications was comparable with previous studies. Pain was the most common complication, although use of analgesia after 2 hours of observation was low. Our findings suggest that post-procedural observation may safely be reduced to two hours but it is currently unknown if early mobilisation following discharge will lead to complications.