The Experts below are selected from a list of 288 Experts worldwide ranked by ideXlab platform
David L. Diehl - One of the best experts on this subject based on the ideXlab platform.
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Endoscopic Ultrasound-guided Liver Biopsy.
Gastrointestinal endoscopy clinics of North America, 2019Co-Authors: David L. DiehlAbstract:Endoscopic-guided Liver Biopsy (EUS-LB) is a more recent approach to doing parenchymal Liver Biopsy, complementing the current methods of percutaneous or transjugular Biopsy. Studies have shown that tissue yields are comparable between the methods. For patients who require an endoscopy or an EUS in addition to a Liver Biopsy, EUS-LB allows combining both procedures at the same time, which is more convenient for patients and can lower health care costs. This chapter will review the technique of EUS-LB, with specific attention paid to needle selection and preparation, endosonographic identification of targets, post-procedure recovery, possible adverse events, as well as tissue handling after Liver Biopsy. A section is included regarding considerations that the pathologist should keep in mind. Future directions for clinical applications and research are also discussed.
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The Role of EUS in Liver Biopsy
Current Gastroenterology Reports, 2019Co-Authors: David L. DiehlAbstract:Purpose of Review EUS-guided Liver Biopsy (EUS-LB) is being used with increased frequency to perform parenchymal Liver Biopsy. Evolution of the technique can now achieve excellent Liver tissue cores. This review covers important developments in this procedure. Recent Findings Clinical studies have recently demonstrated that the 19G EUS core Biopsy needle is superior to non-core needles for Liver tissue acquisition. In addition, wet suction provides more robust tissue samples than dry suction. Heparin priming of the needle (instead of saline) can prevent blood clogging within the needle lumen. A 1-hour recovery time after the EUS-LB is sufficient in almost all cases. The EUS-LB can deLiver bilobar biopsies, which can decrease sampling error. Patients who need a Liver Biopsy in addition to an endoscopy or EUS are best served by the EUS-LB, as the combination procedure saves time and cost. Summary The EUS-LB is a safe and effective means for procuring good Liver core biopsies. Incremental improvements in technique have increased quality of the resulting specimen. Future directions of this technique are discussed.
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The Role of EUS in Liver Biopsy.
Current gastroenterology reports, 2019Co-Authors: Shaffer R. S. Mok, David L. DiehlAbstract:Purpose of Review EUS-guided Liver Biopsy (EUS-LB) is being used with increased frequency to perform parenchymal Liver Biopsy. Evolution of the technique can now achieve excellent Liver tissue cores. This review covers important developments in this procedure.
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Endoscopic ultrasound-guided Liver Biopsy.
Endoscopic ultrasound, 2015Co-Authors: Parth J. Parekh, David L. Diehl, Raj Majithia, Todd H. BaronAbstract:Liver Biopsy remains the cornerstone in the diagnosis and management of Liver disorders. Results of Liver Biopsy can often drive therapeutic decision-making. Unfortunately, studies have shown conventional Biopsy techniques to carry significant sampling variability that can potentially impact patient care. Endoscopic ultrasound (EUS) is gaining traction as an alternative method of Biopsy. For parenchymal disease, it can decrease sampling variability. It offers a more targeted approach for focal lesions. Its diagnostic yield and limited adverse event profile make it a promising approach for Liver Biopsy.
Lawrence S. Friedman - One of the best experts on this subject based on the ideXlab platform.
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Divining the role of Liver Biopsy in hepatitis C.
Journal of hepatology, 2005Co-Authors: Steven K. Herrine, Lawrence S. FriedmanAbstract:Since the first Liver Biopsy was performed by Paul Ehrlich in 1883 [1], the procedure has been a cornerstone of clinical hepatology as well as a lightning rod of controversy. Surveys in Europe and the United States indicate that a majority of Liver biopsies are now performed as part of the evaluation of patients with chronic hepatitis C [2]. Liver Biopsy is useful for identifying those patients at highest risk for progression of hepatic fibrosis, thereby allowing selection of candidates most in need of (although not necessarily most responsive to) antiviral treatment. The procedure is considered safe, with moderate pain reported in 20% of patients, narcotic-requiring pain in 3%, vasovagal episodes in 2%, and severe complications, including bleeding, in 0.6% [3]. Consensus statements from both the European Association for the Study of the Liver and the National Institutes of Health (NIH) recommend Liver Biopsy to aid clinical decision-making in patients with hepatitis C [4,5], thus establishing examination of Liver histology as the standard of care. The development of noninvasive techniques to estimate the degree of hepatic fibrosis [6], along with the increasing success of antiviral regimens [7,8], has led some experts to question the need for routine Liver Biopsy in the management of patients with chronic hepatitis C [9]. To date, however, simple noninvasive tests of hepatic fibrosis, as well as more sophisticated proprietary fibrosis batteries, have not inspired sufficient confidence to displace
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Controversies in Liver Biopsy: who, where, when, how, why?
Current gastroenterology reports, 2004Co-Authors: Lawrence S. FriedmanAbstract:Liver Biopsy continues to have a central role in the evaluation of patients with suspected Liver disease. The procedure is often indicated to evaluate otherwise unexplained Liver biochemical test abnormalities, but the precise degree of serum aminotransferase elevations that should prompt a Liver Biopsy is controversial, as is the need for Liver Biopsy in all patients with suspected nonalcoholic fatty Liver disease and chronic hepatitis C. Standard Liver Biopsy is contraindicated in patients with severe coagulopathy and ascites, although the degree of coagulopathy that contraindicates a Liver Biopsy is controversial. A transjugular approach is an alternative in patients with coagulopathy or ascites. Controversy surrounds all the technical aspects of Liver Biopsy, particularly the choice of needle (cutting vs suction) and the use of ultrasound to mark or guide the Biopsy site. Bleeding is the major complication of Liver Biopsy, with a risk of 0.3%; cutting needles are more likely to cause hemorrhage than are suction needles. Traditionally, Liver Biopsy has been the province of the hepatologist/ gastroenterologist. However, an increasing number of Liver biopsies are performed by radiologists. The implications of this trend with respect to patient outcome, safety, and training of fellows is unclear.
Ana Lleo - One of the best experts on this subject based on the ideXlab platform.
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Role of Liver Biopsy in hepatocellular carcinoma.
World Journal of Gastroenterology, 2019Co-Authors: Luca Di Tommaso, Marco Spadaccini, Matteo Donadon, Nicola Personeni, Abubaker Elamin, Alessio Aghemo, Ana LleoAbstract:The role of Liver Biopsy in the diagnosis of hepatocellular carcinoma (HCC) has been challenged over time by the ability of imaging techniques to characterize Liver lesions in patients with known cirrhosis. In fact, in the diagnostic algorithm for this tumor, histology is currently relegated to controversial cases. Furthermore, the risk of complications, such as tumor seeding and bleeding, as well as inadequate sampling have further limited the use of Liver Biopsy for HCC management. However, there is growing evidence of prognostic and therapeutic information available from microscopic and molecular analysis of HCC and, as the information content of the tissue sample increases, the advantages of Liver Biopsy might modify the current risk/benefit ratio. We herein review the role and potentiality of Liver Biopsy in the diagnosis and management of HCC. As the potentiality of precision medicine comes to the management of HCC, it will be crucial to have rapid pathways to define prognosis, and even treatment, by identifying the patients who could most benefit from target-driven therapies. All of the above reasons suggest that the current role of Liver Biopsy in the management of HCC needs substantial reconsideration.
K. R. Reddy - One of the best experts on this subject based on the ideXlab platform.
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The evolving role of Liver Biopsy: REVIEW: THE EVOLVING ROLE OF Liver Biopsy
Alimentary pharmacology & therapeutics, 2004Co-Authors: M. S. Campbell, K. R. ReddyAbstract:Summary Liver Biopsy is traditionally the ‘gold standard‘ for the evaluation of Liver diseases. There are several situations in which its role is being challenged. In hepatitis C, Liver Biopsy helps assess prognosis and treatment candidacy. An important exception is genotype 2 or 3 because treatment is more likely to succeed and therapy is relatively short in duration. For hepatitis B, Liver Biopsy gives some prognostic information, but serologic tests and hepatic biochemical tests are the primary determinants of treatment candidacy. Non-alcoholic fatty Liver disease can be accurately diagnosed without a Liver Biopsy and, furthermore, there are no specific therapies available. The role of Liver Biopsy to assess methotrexate-associated hepatotoxicity remains controversial. Finally, patients with focal Liver lesions usually do not require Biopsy and, in the case of hepatocellular carcinoma, Biopsy carries a risk of needle-track seeding. In short, the need for Liver Biopsy depends on the specific situation and should be performed when there is sufficient uncertainty about diagnosis, severity of disease, prognosis, and treatment decisions.
Ricardo Moreno-otero - One of the best experts on this subject based on the ideXlab platform.
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Role of percutaneous Liver Biopsy.
Hepatitis monthly, 2012Co-Authors: Mia Rodziewicz, Ricardo Moreno-oteroAbstract:Dear Editor, We read the interesting study by Szymczak et al. [1] regarding the safety and effectiveness of a blind percutaneous Liver Biopsy, where they concluded that the failure rate and the risk of complications are low if indications and contraindications are carefully considered. Moreover, these authors emphasize how important it is that biopsies are performed by skilled and experienced operators. This study raises controversy, however, as although a Liver Biopsy is reasonably safe, it is still an invasive procedure and it is unclear as to whether the histology results affect the management of patients with Liver disease. In addition, the increasing availability of non-invasive techniques for staging hepatic fibrosis, together with new and advanced radiological, immunological, virological and molecular genetic tests, may undermine the future role of Liver Biopsy in clinical practice. It has recently been reported (Bjornsson E, et al., 2011) that patients with typical laboratory features of autoimmune hepatitis (AIH) rarely need a Liver Biopsy for their diagnosis and moreover, that most patients with hallmark features of AIH are likely to have a compatible Liver histology. In the few patients with atypical histology, these findings also have little impact on their clinical management. Thus, a Biopsy might be unnecessary in patients who meet the clinical criteria for AIH. This statement might be considered controversial, particularly in those patients who are difficult to categorize due to an atypical clinical presentation. Diagnosing drug-induced Liver injury relies primarily on careful history taking; nevertheless, we had the opportunity to study two illustrative cases of patients with acute flares of severe hepatitis that underwent ultrasound-guided Liver Biopsy for diagnostic characterization. In these patients the histological findings played a decisive role in determining the specific therapeutic intervention required, which subsequently led to a remission of the acute disease [2][3]. It is generally accepted that a Liver Biopsy in patients with chronic hepatitis B is indicated in order to prescribe antiviral therapy, this is usually when serum ALT is very low and in suspected cases of advanced fibrosis (> F2) who are at risk of developing cirrhosis. Concerning chronic hepatitis C, a Liver Biopsy was previously recommended prior to commencing therapy in order to determine whether treatment was warranted and to assess disease prognosis (grading and staging). In current clinical practice this postulation has been revised and now the main role of a Biopsy is the objective quantification of Liver fibrosis into meaningful clinical groups, in particular, those at risk of progression to cirrhosis. Additionally, histological analysis in chronic viral hepatitis could tentatively include molecular analysis such as in situ hybridization or polymerase chain reaction used to detect occult viral infections, identification of premalignant lesions or in the context of clinical and research protocols [4][5]. In summary, Szymczak et al. [1] confirmed the safety and success of a blind Liver Biopsy and reference an extensive number of studies by experienced authors. In current medical practice, however, the importance of this invasive procedure is based on a well designed clinical rationale and knowledge of its precise indications. It can therefore be stated, that a decision on each individual case must be made in order to obtain helpful information for therapeutic interventions, and to establish an adequate follow-up protocol for prognostic control.
