Significance of Laparascopic Liver Biopsy to Evaluate Hepatic Dysfunction in Patients with Hematologic Disorders.
- Author:
Bo Kyoung KIM
1
;
Kyu Won CHUNG
;
Jae Myung PARK
;
Byung Wook KIM
;
Hwang CHOI
;
Chang Don LEE
;
Sang Wook CHOI
;
Se Hyun CHO
;
Nam Ik HAN
;
Young Suk LEE
;
Byung Min AHN
;
Hee Sik SUN
;
Woo Sung MIN
;
Chun Choo KIM
;
Chang Sik KANG
;
Sang In SIM
Author Information
1. Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Laparascopy;
Hepatic dysfuction;
Hepatitis;
Bone marrow transplantation
- MeSH:
Anemia, Aplastic;
Biopsy*;
Bone Marrow Transplantation;
Cholestasis;
Diagnosis;
Drug Therapy;
Drug-Induced Liver Injury;
Electrocoagulation;
Graft vs Host Disease;
Hematologic Neoplasms;
Hepatitis;
Hepatitis, Chronic;
Humans;
Laparoscopy;
Liver Diseases;
Liver Function Tests;
Liver*;
Needles;
Platelet Count;
Platelet Transfusion
- From:Korean Journal of Medicine
1999;56(4):427-436
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
OBJECTIVE: Hepatic dysfunction frequently occurs in patients with hematologic malignancies and aplastic anemia who receive intensive chemotherapy or bone marrow transplantation (BMT). The role of laparoscopic liver biopsy in patients with hematologic disorders is very important to determine the etiological factors and to make treatment decisions. The aim of the present study was to evaluate the possible causes of liver disease in patients with abnormal liver function tests. METHODS: Laparoscopy guided liver biopsy was performed in 38 subjects who were receiving intensive cytotoxic therapy with BMT or without BMT. Two to three pieces of liver tissues were obtained in each patients using Vim-Silverman needle with electrocoagulation on biopsy site. Platelet transfusions were given if platelet count was less than 50,000/mm3. 39 biopsies were obtained in 38 patients. RESULTS: At the time of liver biopsy, platelet count was 170,000+/-138000/mm3 (range: 42,000 - 798,000/mm3). No procedure-related complications were observed. Biopsy findings after BMT (n=16) revealed graft versus host disease (GVHD) (n=9), drug induced hepatitis (n=6), veno-occlusive disease (n=2), viral hepatitis (n=1), and nonspecific reactive hepatitis (n=1). 3 patients of GVHD associated with other liver diseases such as drug-induced hepatitis, veno-occlusive disease and chronic active hepatitis B. The authors compared histologic diagnosis with laparoscopic findings. Laparoscopic findings of the liver surface were classified by Shimada's code number system. 5 patients who were biopsed before BMT showed cholestasis and fatty changes and it was possible to be treated with allogenic BMT. Histologic diagnosis in patients without BMT (n=18) showed viral hepatitis (n=6), drug induced hepatitis (n=5), non-specific reactive hepatitis (n=1), and others (n=6). In 12 cases (31%) laparoscopic liver biopsy led to a change in medical management. CONCLUSION: Laparascopic liver biopsy has been proven to be an effective means of assessing the cause of liver dysfunction in patients with hematologic disorders. The diagnosis obtained at laparoscopic liver biopsy could be changed the therapeutic plan in 12 of 39 (31%) patients.
