Dana Taib Gharib a, Mohammed Omer Mohammed b, Taha Ahmad Al-Karboly b, Heero Ismael Faraj c, Kawa Abdullah Mahmood b, Nasr Abdulla Qazi b, Karok Hassan Salih b, and Omar Hama Ghalib Azeez d

a KBMS trainee in Gastroenterology and Hepatology, KCGH, Sulaimani, Iraq.

b College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.

c Kurdistan Center of Gastroenterologist, KCGH, Kurdistan Region, Iraq. 

d KBMS Trainee in GI surgery, KCGH, Sulaimani, Kurdistan Region, Iraq.

Submitted: 15/7/2019; Accepted: 27/7/2020; Published: 21/9/2020

DOI Link: https://doi.org/10.17656/jsmc.10258 



Percutaneous Liver Biopsy (PLB) is commonly used for assessing the histopathological status of the liver and thus deciding on diagnosis, prognosis, and management plan of patients. 


To assess the value of Percutaneous Liver Biopsy in decision making in patients referred to Kurdistan Centre for Gastroenterology and Hepatology (KCGH), and searching the common causes of liver enzyme abnormalities especially in patients with the unknown clue of diagnosis.

Patients and Methods

This study was performed in Kurdistan Center for Gastroenterology and Hepatology, between April 2018 and January 2019; Sixty-three patients have been included in this study, which was referred for PLB with different intentions; after appropriate pre-procedural preparation PLB was performed with the aid of a radiologist, and post-procedural follow up of patients was done for 6 hours in the ward. 


The reason of referral for PLB was diagnostic, prognostic, and management in 79.8%, 14.3%, and 6.3% respectively. Common diagnoses in a diffuse parenchymal liver lesion with or without elevated liver enzymes were AIH in 15.8%, DILI in 14.3%, and NASH 14.2%. Percutaneous liver biopsy changed the preliminary diagnosis in 52.3%, and management plan in 34.9% of cases. As PLB is an invasive procedure, 31.7% of patients developed complications, which is in decreasing order including right upper quadrant pain 15.9%, right shoulder pain 5.9%, combined right upper quadrant pain, and right shoulder pain in 3.2%, and vasovagal reaction in 3.2 %.


Percutaneous liver biopsy is a valuable investigation in deciding on diagnosis, the prognosis of liver lesions, and it will help the management plan. The three most common diseases which should be excluded in every patient with diffuse parenchymal liver lesions or elevated liver enzymes are AIH, DILI, and NASH.

Keywords: Percutaneous Liver Biopsy; KCGH; Autoimmune Hepatitis; Kurdistan, Iraq.


Percutaneous Liver Biopsy; KCGH; Autoimmune Hepatitis; Kurdistan, Iraq.


1. Kiyoko Oshima. Do I Need a Liver Biopsy? In: Kia Saeian, Reza Shaker editors. 1st edition. Gewerbestrasse. Springer; 2017.Liver Disorders,A Point of Care Clinical Guide. P 27-40.

2. Younossi ZM, McCullough AJ, Ong JP, Barnes DS, Post A, Tavill A, et al. Obesity and non-alcoholic fatty liver disease in chronic hepatitis C. J Clin Gastroenterol2004;38: 705-709. 

3. Don C. Rockey, Stephen H. Caldwell, Zachary D. Goodman. liver biopsy. Hepatology. 2009; 49 (3): 1017-1044. 

4. Dienstag JL, McHutchison JG. American Gastroenterological Association technical review on the management of hepatitis C. Gastroenterology 2006; 130 (1): 231-264. 

5. Catherine Lucero, Robert S. Brown Jr. Noninvasive Measures of Liver Fibrosis and Severity of Liver Disease. Gastroenterology & Hepatology .2016 Jan; 12 (1): 33-40

6. Simona Leoni, Francesco Tovoli, Lucia Napoli. Current guidelines for the management of non-alcoholic fatty liver disease: A systematic review with comparative analysis. World J Gastroenterol 2018 August 14; 24(30): 3361-3373

7. Kleiner DE, Brunt EM. Nonalcoholic fatty liver disease: pathologic patterns and biopsy evaluation in clinical research. Semin Liver Dis 2012 Feb; 32(1) : 3-13.

8. Shahid Habib, Obaid S. Shaikh. Approach to Jaundice and Abnormal Liver Function Test Results. In: Arun J. Sanyal, Keith D, Editors. Zakim and Boyer’s Hepatology:A Textbook of Liver Disease 7th edition. Philadelphia, PA. Elsevier; 2018. P 99-116.

9. Gopal R Vijayaraghavan, Sheehan David, Myriam Bermudez-Allende. Imaging-guided Parenchymal Liver Biopsy: How We Do It. J Clin Imaging Sci. 2011; 1: 30. 

10. Padia SA, Baker ME, Schaeffer CJ, et al. Safety and efficacy of sonographic-guided random real-time core needle biopsy of the liver. Journal of Clinical Ultrasound. 2009; 37(3) 

11. Sukran Kose, Gursel Ersan, Bengu Tatar. Evaluation of Percutaneous Liver Biopsy Complications in Patients with Chronic Viral Hepatitis. Eurasian J Med. 2015 Oct; 47(3): 161–164.

12. Kr'stev N. Gallbladder puncture - a rare percutaneous liver biopsy complication. Khirurgiia (Sofiia). 2000 ; 56(5-6):32-5.

13. Maya Gambarin-Gelwan. Percutaneous Liver Biopsy. Gastroenterol Hepatol (N Y). 2006 Sep; 2(9): 689–690

14. Sherlock S. Aspiration liver biopsy: technique and diagnostic application. Lancet. 1945; 65 (28):397-401.

15. Sorbi D, McGill DB, Thistle JL, Therneau TM, Henry J, Lindor KD,  et al. An assessment of the role of liver biopsies in asymptomatic patients with chronic liver test abnormalities. Am J Gastroenterol 2000;95:3206-3210.

16. Karen E. Matsukuma, Dongguang Wei, Kai Sun. Diagnosis and differential diagnosis of hepatic graft versus host Disease. J Gastrointest Oncology. 2016;7(Suppl 1):S21-S31

17. Stölzel U, Tannapfel A. Indications for liver biopsy in liver tumors. Zentralbl Chir. 2000;125:606–609.

18.  Hye Young Ju, Jae Young Jang, Soung Won Jeong . The clinical features of drug-induced liver injury observed through liver biopsy: focus on relevancy to autoimmune hepatitis. Clinical and Molecular Hepatology 2012;18:213-218

19. Suzuki A, Brunt EM, Kleiner DE. The use of liver biopsy evaluation in discrimination of idiopathic autoimmune hepatitis versus drug-induced liver injury. Hepatology. 2011; 54(3):931-939.

20. Yilmaz Bilgic, Hakan Harputluoglu, Cengiz Yilmaz. Drug-induced autoimmune hepatitis: a single-center experience. Biomedical Research. 2017; 28 (15): 6528-6532

21. Chhagan Bihari, Archana Rastogi, Shiv Kumar Sarin. Postinfantile Giant Cell Hepatitis: An Etiological and Prognostic Perspective. Hepatitis Research and Treatment. 2013: Article ID 601290: 1-7.

22. Boberg KM, Chapman RW, Hirschfield GM,. Overlap syndromes: The International Autoimmune Hepatitis Group (IAIHG) position statement on a controversial issue. J Hepatol 2011;54:374-85.

23. AJ Czaja. Diagnosis and management of the overlap syndromes of autoimmune hepatitis. Can J Gastroenterol 2013;27 (7):417-423.

24. Beuers U, Boberg KM, Chapman RW. EASL clinical practice guidelines: Management of cholestatic liver diseases. J Hepatol 2009;51:237-67.

25. Chalasani N, Younossi Z, Lavine JE. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology. 2012; 142:1592–1609.

26. Mohammed O. Mohammed. Prevalence of Hepatitis-B and Hepatitis-C among Blood Donors Sulaimani City. (JZC) Journal of Zankoy Sulaimani, September 2006; 9(1): Part A 115-124.

27. Muthana A. Yassin. Prevalence of Hepatitis B Surface Antigen among Premarital People In Sulaimani / Iraq. World Journal of Pharmacy and Pharmaceutical Sciences. 2018: 7(9), 138-156.

28.  Antoine Abou Rached, Jowana Saba, Tarek Haykal.  Role of Liver Biopsy in Patients With Chronic Hepatitis B Who did not Fulfill the Criteria for Immediate Treatment.  Journal of GHR. 2017 ; 6(4): 2400-2404.

29. Erin M. M. Kelly, Vickie A. Feldstein, Monica Parks. An Assessment of the Clinical Accuracy of Ultrasound in Diagnosing Cirrhosis in the Absence of Portal Hypertension. Gastroenterol Hepatol (N Y). 2018; 14(6): 367–373.

30. Ratziu V, Charlotte F, Heurtier A . LIDO Study Group. Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology. 2005;128(7):1898–1906.

31. Claudia Spycher, Arthur Zimmermann, Juerg Reichen. The diagnostic value of liver biopsy. BMC Gastroenterology. 2001; 1:12.

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