A survey of current liver biopsy practice patterns

Goals: To survey clinicians regarding cur-rent liver biopsy practice patterns. Background: Although the hepatitis C epidemic has increased the proportion of hepatology in general gastroenterology practice, many clinicians express concern regarding the risks of percutaneous liver biopsy. Study: A questionnaire about liver biopsy practices was sent to members of the Duke University Digestive Epidemiological Studies Consortium. Results: The response rate was 112 (71%) of 157. Thirty-three (29.5%) physicians reported that they do not perform liver biopsies. Reasons cited for not performing biopsies included concern about risks (72.7%), low reimbursement (66.7%), and logistical issues with space and recovery time (45.4%). Routine practice was biopsy without ultrasound in 53.2%, ultrasound marking by a radiologist or technician at the time of biopsy in 24.0%, previous ultrasound marking in 17.7%, and ultrasound marking by the gastroenterologist in 5.1%. For patients with hepatitis C, 76.8% of clinicians perform routine biopsies before treatment. Conclusions: A significant proportion of clinicians do not perform liver biopsies; common reasons include the risks of the procedure and the low reimbursement. The use of ultrasound with liver biopsy has become more common. New approaches, especially in training programs, may be necessary to make clinicians more comfortable with this procedure.