Liver biopsy is the standard procedure for the investigation of a wide range of liver pathologies. It is generally a safe procedure but mortality rates range from 1:1000 to 1:10 000.1 ,2Although a biopsy sample is traditionally taken “blind”, many centres now carry out biopsies under ultrasound control, and this change in technique has impacted directly on the training of general physicians and gastroenterologists. In this article, we review the evidence for the safety of a real time ultrasound guided approach against the traditional blind biopsy, and examine the implications of this change for trainee clinicians who rotate through centres who now use an ultrasound guided technique.

The basic technique for liver biopsy was first described by Sherlock in 19453; the earliest approaches used Tru-Cut and Menghini needles to remove tissue and required inpatient care for 24 hours after the procedure. More recently, liver biopsy patients have been day cases, with no evidence of increased risk.4 Histological diagnosis provides useful guidance for the future management of many liver conditions, and is particularly useful in the recommendation of interferon treatment for patients with hepatitis C. The wide availability of ultrasonography has increased the use of direct visualisation in liver biopsy which has, consequently, improved the …