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Open Access Research article

Percutaneous ultrasonographically guided liver punctures: an analysis of 1961 patients over a period of ten years

Michael Mueller1, Wolfgang Kratzer1*, Suemeyra Oeztuerk1, Manfred Wilhelm2, Richard Andrew Mason3, Ren Mao4 and Mark Martin Haenle1

Author Affiliations

1 Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany

2 Department of Mathematics, Natural Sciences and Economic Studies (Biostatistics), University of Applied Sciences Ulm, Albert-Einstein-Allee 55, 89081, Ulm, Germany

3 Louis Stokes Cleveland Department of Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, Ohio, 44106, USA

4 Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan II road, 510080, Guangzhou, P.R. China

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BMC Gastroenterology 2012, 12:173  doi:10.1186/1471-230X-12-173

Published: 5 December 2012



Ultrasonographically guided punctures of the liver represent a decisive tool in the diagnosis of many diseases of the liver. Objective of the study was to determine the extent to which the complication rate for ultrasonographically guided punctures of the liver is affected by less comprehensively studied risk factors.


A total of 2,229 liver biopsies were performed in 1,961 patients (55.5% males; 44.5% females). We recorded actual complications and assessed the following risk factors: needle gauge, puncture technique, examiner experience, coagulation status, puncture target (focal lesion versus parenchyma), lesion size, patient sex and age.


he rate of complications stood at 1.2% (n = 27), of which 0.5% (n = 12) were major and 0.7% (n = 15) minor complications. A significant increase in complications involving bleeding was observed with larger-gauge needles compared with smaller-gauge needles and for cutting biopsy punctures compared with aspiration biopsies (Menghini technique). In the bivariate analysis complications were 2.7 times more frequent in procedures performed by experienced examiners compared with those with comparatively less experience. Lower values for Quick’s test and higher partial thromboplastin times were associated with a higher rate of bleeding. Neither the puncture target, lesion size or patient sex exerted any measurable influence on the puncture risk. Advanced patient age was associated with a higher rate of complications involving bleeding.


Our study helps to establish the importance of potential and less comprehensively studied risk factors and may contribute to further reduction in complications rates in routine clinical practice.

Liver; Biopsy; Ultrasonography; Complications; Risk factors