COMMENT

One of the most difficult management decisions in clinical hepatology, especially for the general gastroenterologist, is whether to perform a liver biopsy in a patient with abnormal liver function tests, particularly in the absence of diagnostic serology, or a history of drug or alcohol use. At first sight the benefits of performing an invasive procedure in such asymptomatic patients are not obvious when balanced against the potential hazards of bile leak or haemorrhage.¹

Histological causes of abnormal liver biochemistry have been studied previously in patients with excess alcohol ingestion or advanced liver disease.^2,3 However, to date, there have been few published histological data on asymptomatic patients with persistently abnormal liver enzyme abnormalities on which to base management decisions such as liver biopsy. In a recent Scandinavian study, 150 asymptomatic patients with elevated serum transaminases underwent liver biopsy.⁴ While fibrosis was observed in half of the biopsies, only 2% were cirrhotic, and in the majority a mild …