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  1. Article ; Online: Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology.

    Neuberger, James / Patel, Jai / Caldwell, Helen / Davies, Susan / Hebditch, Vanessa / Hollywood, Coral / Hubscher, Stefan / Karkhanis, Salil / Lester, Will / Roslund, Nicholas / West, Rebecca / Wyatt, Judith I / Heydtmann, Mathis

    Gut

    2020  Volume 69, Issue 8, Page(s) 1382–1403

    Abstract: Liver biopsy is required when clinically important information about the diagnosis, prognosis or ... several approaches to liver biopsy but predominantly percutaneous or transvenous approaches are used. A wide choice ... for a more rational, evidence-based approach to peri-biopsy management. Overall, liver biopsy is safe ...

    Abstract Liver biopsy is required when clinically important information about the diagnosis, prognosis or management of a patient cannot be obtained by safer means, or for research purposes. There are several approaches to liver biopsy but predominantly percutaneous or transvenous approaches are used. A wide choice of needles is available and the approach and type of needle used will depend on the clinical state of the patient and local expertise but, for non-lesional biopsies, a 16-gauge needle is recommended. Many patients with liver disease will have abnormal laboratory coagulation tests or receive anticoagulation or antiplatelet medication. A greater understanding of the changes in haemostasis in liver disease allows for a more rational, evidence-based approach to peri-biopsy management. Overall, liver biopsy is safe but there is a small morbidity and a very small mortality so patients must be fully counselled. The specimen must be of sufficient size for histopathological interpretation. Communication with the histopathologist, with access to relevant clinical information and the results of other investigations, is essential for the generation of a clinically useful report.
    MeSH term(s) Antibiotic Prophylaxis ; Anticoagulants/therapeutic use ; Biopsy/adverse effects ; Biopsy/instrumentation ; Biopsy/methods ; Biopsy/standards ; Blood Coagulation Tests ; Contraindications, Procedure ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Humans ; Informed Consent ; Interdisciplinary Communication ; Laparoscopy ; Liver/pathology ; Needles ; Patient Selection ; Postoperative Care/standards ; Professional Role
    Chemical Substances Anticoagulants
    Language English
    Publishing date 2020-05-28
    Publishing country England
    Document type Journal Article ; Practice Guideline
    ZDB-ID 80128-8
    ISSN 1468-3288 ; 0017-5749
    ISSN (online) 1468-3288
    ISSN 0017-5749
    DOI 10.1136/gutjnl-2020-321299
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 160: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

    Order via subito

    This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

  2. Article: Guidelines on the use of liver biopsy in clinical practice. British Society of Gastroenterology.

    Grant, A / Neuberger, J

    Gut

    1999  Volume 45 Suppl 4, Page(s) IV1–IV11

    MeSH term(s) Ambulatory Care ; Biopsy/methods ; Biopsy/mortality ; Blood Coagulation Disorders/complications ; Contraindications ; Decision Making ; Humans ; Liver/pathology ; Liver Diseases/mortality ; Liver Diseases/pathology ; Patient Selection
    Language English
    Publishing date 1999-10
    Publishing country England
    Document type Guideline ; Journal Article ; Practice Guideline
    ZDB-ID 80128-8
    ISSN 1468-3288 ; 0017-5749
    ISSN (online) 1468-3288
    ISSN 0017-5749
    DOI 10.1136/gut.45.2008.iv1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 160: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

    Order via subito

    This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

  3. Article ; Online: Review article: the management of autoimmune hepatitis beyond consensus guidelines.

    Czaja, A J

    Alimentary pharmacology & therapeutics

    2013  Volume 38, Issue 4, Page(s) 343–364

    Abstract: ... by the American Association for the Study of Liver Diseases and 48% of those proposed by the British Society ... uncertainties in diagnosis relate to the timing of liver biopsy, recognising acute severe (fulminant) disease ... of Gastroenterology are based on low-quality evidence, conflicting experiences or divergent opinions. The key ...

    Abstract Background: Consensus guidelines aid in the diagnosis and management of autoimmune hepatitis, but they are frequently based on low-quality clinical evidence, conflicting experiences and divergent opinions. Recommendations may be weak, discrepant or non-existent at critical decision points.
    Aims: To identify the decision points where guidelines are weak or non-existent and review the evidence essential in the decision process.
    Methods: Full-text articles published in English using the keyword 'autoimmune hepatitis' were identified by PubMed from 1972 to 2013. Personal experience and investigations in autoimmune hepatitis also identified important contributions.
    Results: Seventy per cent of the guidelines developed by the American Association for the Study of Liver Diseases and 48% of those proposed by the British Society of Gastroenterology are based on low-quality evidence, conflicting experiences or divergent opinions. The key uncertainties in diagnosis relate to the timing of liver biopsy, recognising acute severe (fulminant) disease, interpreting coincidental nonclassical histological changes, accommodating atypical or deficient features in non-White patients, differentiating drug-induced from classical disease and identifying overlap syndromes. The key uncertainties in management relate to pre-treatment testing for thiopurine methyltransferase activity, treating asymptomatic mild disease, determining treatment end points, managing suboptimal responses, incorporating nonstandard medications as front-line and salvage agents, using azathioprine in pregnancy and instituting surveillance for hepatocellular carcinoma.
    Conclusions: Consensus guidelines are fraught with uncertainties in the diagnosis and management of autoimmune hepatitis. Each decision point must counterbalance the current available evidence and tailor the application of this evidence to the individual patient.
    MeSH term(s) Consensus Development Conferences as Topic ; Hepatitis, Autoimmune/diagnosis ; Hepatitis, Autoimmune/drug therapy ; Humans ; Immunosuppressive Agents/therapeutic use ; Practice Guidelines as Topic ; Severity of Illness Index ; Treatment Outcome
    Chemical Substances Immunosuppressive Agents
    Language English
    Publishing date 2013-08
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 639012-2
    ISSN 1365-2036 ; 0269-2813 ; 0953-0673
    ISSN (online) 1365-2036
    ISSN 0269-2813 ; 0953-0673
    DOI 10.1111/apt.12381
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 2206: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

    Order via subito

    This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

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