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. 2013 Nov;27(11):e31-4.
doi: 10.1155/2013/429834.

Percutaneous liver biopsy practice patterns among Canadian hepatologists

Mohammed Aljawad, Eric M Yoshida, Julia Uhanova, Paul Marotta, Natasha Chandok

Percutaneous liver biopsy practice patterns among Canadian hepatologists

Mohammed Aljawad et al. Can J Gastroenterol. 2013 Nov.

Abstract
in English, French

Background: Percutaneous liver biopsy (PLB) is the standard procedure to obtain histological samples essential for the management of various liver diseases. While safe, many hepatologists no longer perform their own PLBs; the reasons for this practice shift are unknown.

Objective: To describe the attitudes, practice patterns and barriers to PLB among hepatologists in Canada.

Methods: A survey was distributed to all hepatologists in Canada.

Results: Thirty-two of 40 (80%) hepatologists completed the survey; the majority of respondents were male (72%) and had been in practice for >5 years in an academic setting. Fifty-six per cent of hepatologists referred all PLBs to radiology, and only 19% of hepatologists reported performing their own PLBs most or all of the time. There were no sex differences nor were there differences based on years in practice. Fifty per cent of respondents who performed PLB routinely used ultrasound, and PLBs are performed in equal frequency in an ambulatory procedure area (50%) versus the endoscopy suite (36%). For almost one-half of hepatologists (47%), their performance of PLBs decreased in the past five years. The majority of respondents at an academic centre (75%) reported access to FibroScan (Echosens, France), and most estimated a resultant 25% to 50% reduction in the need for PLBs. Lack of resources, patient preference and suboptimal reimbursement were the most common reasons cited for not performing PLBs.

Conclusion: Most hepatologists in Canada do not perform PLBs to the extent that they did in the past, but refer to radiology. The reasons for this shift in practice include lack of resources, improved perception of safety and patient preference. Where available, FibroScan resulted in a perceived 25% to 50% reduction in required liver biopsies.

HISTORIQUE :: La biopsie hépatique percutanée (BHP) est l’intervention standard pour obtenir des échantillons histologiques essentiels à la prise en charge de diverses maladies hépatiques. Bien qu’elle soit sécuritaire, de nombreux hépatologues ne l’exécutent plus eux-mêmes, sans qu’on sache pourquoi.

OBJECTIF :: Décrire les attitudes, les modèles de pratique et les obstacles à la BHP chez les hépatologues du Canada.

MÉTHODOLOGIE :: Tous les hépatologues du Canada ont reçu un sondage.

RÉSULTATS :: Trente-deux des 40 hépatologues (80 %) ont rempli le sondage, dont la majorité étaient des hommes (72 %) et exerçaient en milieu universitaire depuis plus de cinq ans. Cinquante-six pour cent des hépatologues aiguillaient toutes les BHP en radiologie, et seulement 19 % déclaraient effectuer leurs propres BHP dans la plupart ou la totalité des cas. On ne constatait aucune différence selon le sexe ou les années de pratique. Cinquante pour cent des répondants qui effectuaient systématiquement les BHP le faisaient par échographie, et les BHP étaient exécutées tout autant en consultations externes (50 %) qu’en salle d’endoscopie (36 %). Près de la moitié des hépatologues (47 %) avaient réduit leur nombre de BHP depuis cinq ans. La majorité des répondants d’un centre universitaire (75 %) signalaient l’accès au FibroScan (Echosens, France), et la plupart estimaient que cet appareil réduisait de 25 % à 50 % la nécessité d’effectuer des BHP. Le manque de ressources, les préférences des patients et le remboursement sous-optimal étaient les principales raisons citées pour ne pas effectuer de BHP.

CONCLUSION :: La plupart des hépatologues du Canada n’effectuent pas autant de BHP que par le passé, mais aiguillent leurs patients en radiologie. Ce changement de pratique s’explique par le manque de ressources, une meilleure perception de la sécurité et la préférence du patient. Lorsqu’elle est accessible, le FibroScan suscitait une réduction perçue de 25 % à 50 % des biopsies hépatiques requises.

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Figures

Figure 1)
Figure 1)
Years of practice according to sex
Figure 2)
Figure 2)
Frequency of performance of percutaneous liver biopsy in male verus female hepatologists
Figure 3)
Figure 3)
Performance of percutaneous liver biopsy (PLB) according to years of practice
Figure 4)
Figure 4)
Per cent reduction in percutaneous liver biopsy due to FibroScan (Echosens, France)
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