Is laparoscopy an advantage in the diagnosis of cirrhosis in chronic hepatitis C virus infection?

AIM:To evaluate the potential of laparoscopy in thediagnosis of cirrhosis and outcome of interferon treatmentin HCV-infected patients.METHODS:In this retrospective study,diagnostic laparoscopywith laparoscopic liver biopsy was performed in 72 consecutivepatients with chronic HCV infection.The presence or absenceof drrhosis was analyzed macroscopically by laparoscopy andmicroscopically by liver biopsy specimens.Clinical andlaboratory data and outcome of interferon-alfa treatmentwere compared between cirrhotic and noncirrhotic patients.RESULTS:Laparoscopically,cirrhosis was seen in 29.2 %(21/72)and non-cirrhosis in 70.8 %(51/72)of patients.Cirrhotic patients were significantly older with a significantlonger duration of HCV infection than noncirrhotic patients.Laboratory parameters(AST,y-GT,y-globulin fraction)weremeasured significantly higher as well as significantly lower(prothrombin index,platelet count)in cirrhotic patients thanin non-cirrhotic patients.Histologically,cirrhosis was confirmedin 11.1%(8/72)and non cirrhosis in 88.9 %(64/72).Patientswith macroscopically confirmed cirrhosis(n=21)showedhistologically cirrhosis in 38.2 %(8/21)and histologically non-cirrhosis in 61.9 %(13/21).In contrast,patients withmacroscopically non-cirrhosis(n=51)showed histologicallynon cirrhosis in all cases(51/51).Thirty-nine of 72 patientswere treated with interferon-alfa,resulting in 35.9 %(14/39)patients with sustained response and 64.1%(25/39)withnon response.Non-responders showed significantly moremacroscopically cirrhosis than sustained responders.Incontrast,there were no significant histological differencesbetween non-responders and sustained responders.CONCLUSION:Diagnostic laparoscopy is more accuratethan liver biopsy in recognizing cirrhosis in patients withchronic HCV infection.Liver biopsy is the best way to assessinflammatory grade and fibrotic stage.The invasive marker forstaging,prognosis and management,and treatment outcomeof chronic HCV-infected patients need further research anddinical thals.Laparoscopy should be performed for recognitionof drrhosis if this parameter is found to be of prognostic andtherapeutic relevance in patients with chronic HCV infection.