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Background: The aim of this study was to determine whether the pretreatment laparoscopic appearance of the liver is an additional predictor of response to combination therapy with interferon and ribavirin in patients with hepatitis C., Methods: A retrospective review was performed of 112 patients (61 men, 51 women [ratio 1.3:1]; mean age 50 [10] years, range 15-73 years) with untreated hepatitis C, without other causes of liver disease, who underwent diagnostic laparoscopy before combination therapy with interferon and ribavirin for at least 24 weeks with a 24-week post-treatment follow-up. Fifty-nine were white, 37 Hispanic, and 16 African American. Patients were divided into responders and non-responders based on viral clearance. Demographics, genotype, pre-therapy hepatitis C virus RNA, histopathologic, and laparoscopic appearances were analyzed., Results: Ninety-three patients (83%) had genotype 1 with a mean pretreatment hepatitis C virus RNA of 3.2 (2.8) million copies/mL. Thirty-seven (33%) had laparoscopic evidence of cirrhosis, whereas, only 30 (26.4%) had cirrhosis by histopathologic criteria. Patients were treated with interferon and ribavirin (mean dose 10.6 [2.5] mg/kg) for a mean duration of 37.7 (11.4) weeks, depending on response and genotype. A sustained response was observed in 26 (23%) patients; in 12 (11%), there was only a biochemical response (biochemical responder), while 59 (53%) and 15 (13%) were classified, respectively, as non-responders and relapsers. Logistic regression analysis revealed that pretreatment laparoscopic appearance (p = 0.034) and genotype (p = 0.002) were significant predictive factors; that is, a lesser extent of fibrosis at laparoscopy and genotypes other than 1 were predictive of a sustained response to combination therapy., Conclusions: Pretreatment laparoscopic appearance alone and genotype are significant predictors of a sustained response to combination therapy in patients with hepatitis C. Laparoscopy and biopsy are complementary for the diagnosis of cirrhosis in hepatitis C.

Background: Percutaneous liver biopsy fails to demonstrate cirrhosis in approximately 32% of cases when compared with laparoscopy with liver biopsy. The aim of this study is to determine the usefulness of small-diameter (2 mm) laparoscopes compared with larger laparoscopes., Methods: Patients undergoing diagnostic laparoscopy for various liver diseases were evaluated with small-diameter (2 mm) laparoscopes either alone or in combination with a 5 or 10 mm laparoscope., Results: Twenty patients were enrolled in this study. Small-diameter laparoscopes provided appropriate visualization of the abdominal organs and proper guidance to liver biopsy in 9 cases. In the remaining 11 cases a larger laparoscope was used for the following reasons: short length of the trocar/introducer in a morbidly obese patient (1), liver mass located in the anterosuperior aspect of the liver precluding good visualization with forward lenses (1), and inability to properly visualize the anterosuperior aspect of the liver (9). No complications were noted with the use of the small-diameter laparoscopes alone., Conclusion: There is a need for an oblique-viewing minilaparoscope that allows visualization comparable to the larger laparoscopes.

Background: A definitive diagnosis of cirrhosis is important in the prognosis and management of patients with chronic liver disease. The diagnosis of cirrhosis is made either by histologic examination of a biopsy specimen or upon visualization of a diffusely nodular and firm surface of the liver at laparotomy or laparoscopy. A liver biopsy, however, may not demonstrate the histologic features of cirrhosis in some cirrhotic patients. Our goal in this study was to compare the accuracy of liver descriptions made during laparoscopy with liver histology found by laparoscopic biopsy in patients with chronic liver disease., Methods: A retrospective review of paired laparoscopy and histology reports was performed on 434 consecutive patients who underwent laparoscopy between 1992 and 1994. (M:F ratio, 1.3:1; mean age, 48 +/- 14 years)., Etiology: 52% hepatitis C, 8% hepatitis B, 8% fatty liver, 4% primary biliary cirrhosis, 3% autoimmune hepatitis, and 25% miscellaneous (cancer patients were excluded)., Results: One hundred sixty-nine patients had laparoscopic evidence of cirrhosis; 115 were confirmed by histology, representing a 32% sampling error. Two of 265 patients with histologic evidence of cirrhosis (0.8%) had no macroscopic evidence of cirrhosis at laparoscopy., Conclusions: (1) There was a 32% histologic sampling error among patients documented to have cirrhosis by laparoscopy. (2) Using laparoscopy as a gold standard, the sensitivity of liver biopsy was 68% and the specificity was 99%.

Hepatic dysfunction frequently develops in patients infected with the human immunodeficiency virus (HIV). This retrospective study was undertaken to determine the laparoscopic and histologic findings in a group of HIV-seropositive patients with or without the acquired immune deficiency syndrome (AIDS). Fifty-four patients, 44 with AIDS and 10 HIV-positive, underwent laparoscopic examination and visually guided biopsies for the assessment of clinical or biochemical evidence of liver injury. Significant abnormalities were detected in 31/44 (70%) AIDS patients and 3/10 (30%) HIV-positive patients. Overall, specific laparoscopic findings were described in 25/54 (46%). The most common findings were peritoneal involvement, massive intra-abdominal adhesions, focal lesions of the liver or spleen, and diffuse nodularity of the liver; these were usually related to opportunistic infections or neoplasms such as non-Hodgkin's lymphomas and Kaposi's sarcoma. No procedure-related deaths occurred. Laparoscopy is a safe and accurate method to detect underlying disease in a selected population of HIV-seropositive patients.

Laparoscopy is an underutilized endoscopic procedure in the United States even though it has proven to be an important diagnostic modality. Among factors that may account for the unpopularity of this procedure are lack of experience and proper training in many gastroenterology fellowship programs, a perceived notion that there is a relatively high complication rate, and the preference for radiologic imaging techniques for establishing a diagnosis. We reviewed, over an 11-month period, our experience with laparoscopy in a large teaching center to better assess its safety when performed by trainees. The major and minor complication rates were 0.9% and 2.9%, respectively, with no fatalities. These findings compare favorably with the general experience.

Two new prototype probes, BICAP and Heater, were assessed to determine their effectiveness in controlling post-biopsy bleeding during laparoscopy. A total of 88 patients with a wide spectrum of liver diseases were studied. Both probes were equally effective in stopping bleeding in all patients. We recommend the use of either of these devices in controlling post-biopsy bleeding.