Diagnostic laparoscopy by physicians: we should do it.

Only a few centres in the UK practise diagnostic laparoscopy and liver biopsy; in comparison, laparoscopy is widely practised by physicians in Europe, the Far East and in the US. We consider the role of diagnostic laparoscopy in the assessment of liver disease in the 1990s, and describe the technique of laparoscopy, including how it may be performed safely in the endoscopy suite, under local anesthesia with mild sedation and analgesia, enabling direct visualization of the liver. We examine potential complications and contraindications. Complication rate and mortality are similar to that for percutaneous liver biopsy. Finally, the invaluable role of laparoscopy in diagnosing and staging chronic hepatitis, cirrhosis, liver tumours, hepatic infiltration, infection and structural abnormalities is considered.