Liver biopsy

A biopsy is the removal of a small piece of liver tissue for further examination under a microscope. A liver biopsy can be performed in various ways. The most common method is the “liver biopsy via a skin puncture (percutaneous).” Another technique is the liver biopsy via the veins (transjugular).

Liver biopsy via skin puncture

In a percutaneous liver biopsy, a special needle is inserted through the skin into the liver. A small sample of liver tissue is then removed for examination in the laboratory. A percutaneous liver biopsy is the most commonly used method for liver biopsies and takes an average of 15 minutes.

Liver biopsy via the veins

In this type of liver biopsy, the doctor accesses the liver through the blood vessels and then removes a small sample of liver tissue for examination. This transjugular liver biopsy takes about 30 to 60 minutes.

During a liver biopsy, a small piece of tissue is removed from the liver for examination. A liver biopsy may be necessary to investigate the cause, progression, or treatment of a specific liver disease. Even when the diagnosis is already known, a liver biopsy is sometimes performed. This is done to determine the severity of liver damage, to initiate the appropriate treatment, or to assess the effectiveness of a treatment that has already been started.

A liver biopsy can be used to diagnose many different liver conditions:

• Fatty Liver Disease
• Liver fibrosis (formation of connective tissue)
• Cirrhosis of the Liver
• Liver inflammation caused by a virus or another disease
• Copper accumulation (Wilson's disease)
• Iron accumulation (iron overload disease—hemochromatosis)
• A tumor can also be biopsied under ultrasound guidance (to a lesser extent in the case of a transjugular liver biopsy).

• You must fast for at least 6 hours before the procedure. This means you must not eat, drink, or smoke for 6 hours before the liver biopsy.
• In the room, another blood sample will be taken, if necessary, to check your blood clotting.
• Please use the restroom one more time before the exam.
• A patient gown will be waiting for you in your room; please feel free to put it on.
• Jewelry should be removed.

Please note the following before the study begins:

• Any allergies
• Taking blood-thinning medications, such as cardioaspirin, Plavix, Marcoumar, clopidogrel, Ticlid, Xarelto, Pradaxa, Eliquis, Brilique, Marevan, Sintrom, etc. You may need to stop taking these medications before the biopsy to reduce the risk of bleeding during or after the procedure. Your doctor will explain how far in advance you need to stop taking these medications.
• Taking anti-inflammatory medications
• If you normally take medication in the morning, please ask your doctor before your admission whether you may take it on the day of the exam.
• If you have diabetes, we can discuss whether your insulin dose needs to be adjusted on the day of admission.

Liver biopsy via skin puncture

• For the exam, lie on your back with your right arm behind your head.
• First, the doctor uses an ultrasound machine to determine the correct site for the biopsy.
• The injection site is marked and disinfected. This may feel a little cold.
• The skin is numbed locally, which may be slightly painful.
• The doctor makes a small incision after the local anesthetic has taken effect.
• The biopsy needle is inserted along the incision until it reaches the liver, and a small sample of liver tissue is removed.
• The needle is removed.
• The small piece of liver tissue is collected in a cup and sent to the laboratory for further examination.
• Sometimes a second or third injection is given.
• The puncture site is covered.

Liver biopsy via the veins

• A few electrodes are attached to the wrists and chest to monitor the heart rhythm.
• You will be lying on your back, and the doctor will ask you to look to the left so that your neck is easily accessible.
• The skin around the neck is disinfected and numbed. The injection needed for the anesthesia may be painful. After that, the examination is painless.
• A needle is inserted into the jugular vein. A sheath (a hard, hollow plastic tube) is placed inside the vein. A catheter is inserted through this sheath. It is advanced to the liver under the guidance of contrast dye and X-rays. A needle is then inserted over this first catheter. The doctor will use this needle to take a small sample of liver tissue.
• The needle is removed.
• The small piece of liver tissue is collected in a cup and sent to the laboratory for further examination.
• Finally, the doctor applies a bandage to the neck.
• Sometimes, during a transjugular liver biopsy, pressure measurements are also taken at the level of the hepatic veins.

Liver biopsy via skin puncture

Immediately after the examination

• You should lie on your right side for at least 2 hours to apply some extra pressure to the injection site and thus reduce the risk of post-injection bleeding.
• After that, you’ll need to stay in bed for another 2 hours (except to use the restroom; if necessary, you’ll have to use a bedpan or urinal).
• You may eat again 3 hours after the exam.
• The nurse will check your blood pressure and pulse on a regular basis.
• Sometimes, an overnight stay is scheduled following a liver biopsy.
• After the liver biopsy, you may feel pain in your upper abdomen or right shoulder, which may sometimes worsen when you take a deep breath. It’s best to let the nurse know if this happens.

The next few days

• Avoid lifting heavy objects for the first few days.
• Do not take a bath for the first 4 days because of the small incision that was made. Showering is fine.

Liver biopsy via the veins

• To prevent bleeding from the injection site, you should remain in a semi-sitting position for up to 4 hours. After that, you may get out of bed slowly.
• The nurse will check your blood pressure and pulse on a regular basis.
• The bandage is checked for any signs of continued bleeding.

• The risk of bleeding is less than 1 in 1,000
• The puncture may cause blood or bile to leak into the abdomen
• In very rare cases, the puncture site in the liver must be sutured closed during keyhole surgery.