Published online Nov 14, 2015. doi: 10.3748/wjg.v21.i42.12141
Peer-review started: July 30, 2015
First decision: September 11, 2015
Revised: September 23, 2015
Accepted: September 30, 2015
Article in press: September 30, 2015
Published online: November 14, 2015
Liver biopsy is a standard method used for obtaining liver tissue for histopathological evaluation. Since reliable serological and virological tests are currently available, liver biopsy is no longer needed for the etiological diagnosis of chronic hepatitis B and C. However, liver histology remains the gold standard as a prognostic tool, providing information about the liver disease progression (grading of necroinflammatory activity and staging of fibrosis) and serving clinicians in the management and therapeutic decisions. In general, histopathological evaluation is indicated before starting the antiviral treatment. Main limitations of the liver biopsy include its invasive and painful procedure, sampling errors and the inter- and intra-observer variability. In addition, indications for the liver biopsy in pediatric patients with chronic viral hepatitis were questioned recently, and efforts have been made toward the development of non-invasive methods as an alternative to the liver biopsy. The most commonly used methods are novel imaging studies (elastography) and combinations of biomarkers. However, to date, none of these tests was validated in children with chronic viral hepatitis. In this review, we present the current status of the liver biopsy in the management of chronic viral hepatitis B and C in pediatric population, including specific indications, complications, contraindications, problems, limitations, and alternative non-invasive methods.
Core tip: The role of liver biopsy in pediatric patients with chronic viral hepatitis was questioned recently due to the development of non-invasive alternative methods (novel imaging studies and combinations of biomarkers) used for the assessment of the severity of liver fibrosis. However, none of these methods has been validated in children so far, and therefore liver biopsy remains the gold standard for the evaluation of liver disease progression in children with chronic viral hepatitis. In addition, it is a crucial tool for the management and for therapeutic decisions.