Liver Biopsy and Laparoscopy

Since its introduction into clinical practice in the 1800s, liver biopsy has served as an invaluable tool in the evaluation and management of liver diseases. Over the years, the technique of percutaneous liver biopsy has been refined and has proven to be safe, with low rates of reported complications. A transjugular approach to liver biopsy should be used in those with contraindications to percutaneous liver biopsy. An added benefit of the transjugular liver biopsy is the ability to measure the portosystemic pressure gradient. Although less frequently done, laparoscopy is a safe and useful tool in the diagnosis of liver disease and can be used to observe the gross appearance of the liver, perform targeted biopsies, and obtain peritoneal samples. Despite the fact that there are several noninvasive techniques under evaluation for the diagnosis and management of liver disease, tissue sampling by percutaneous, transjugular, or laparoscopic approaches is unlikely to fall by the wayside in the near future.