A liver biopsy is an invasive procedure used to collect a sample of liver tissue for analysis. It is regarded as one of the most effective methods for diagnosing liver problems. Liver biopsies are often performed when other methods, such as diagnostic imaging tests, fail. They are also used to determine the extent of damage in known cases of liver disease. Your doctor will determine if a liver biopsy is the right choice for you.
Before the Biopsy
Prior to your appointment, you should speak with your doctor about any medications you are taking. Your doctor may ask you to stop taking certain medications that could increase the risk of bleeding during or after the procedure.
Medicines you may be asked to discontinue for a period before and after the biopsy include:
- Blood pressure medication
- Blood thinners
- Certain asthma medications
- Certain diabetes medications
- Certain vitamin and mineral supplements
- NSAIDs (Non-steroidal anti-inflammatory drugs) such as aspirin and ibuprofen
Blood Clotting Tests
A doctor will check your blood to ensure that it is clotting properly before performing a liver biopsy. If your blood is clotting abnormally, you may be given medication to help reduce the risk of bleeding.
You will be advised not to eat or drink anything for at least 8 hours before the liver biopsy. If the biopsy is to take place in the morning, your doctor may recommend that you do not eat or drink anything after midnight on the night before the procedure.
Often you will receive a mild calming sedative prior to the procedure. Although you probably will not remember the procedure, you will have been conscious and capable of communicating. Keep in mind that if you are given a sedative, you will require an adult chaperone to assist you in getting home, as you cannot drive after sedation.
The Three Types of Liver Biopsies:
Transvenous liver biopsy
Laparoscopic liver biopsy
The percutaneous biopsy is the most commonly performed liver biopsy, although it is not an option for everyone. During the procedure, you will lie on your back with your right arm raised over your head. You may have an IV to supply you with a sedative and any pain medication you may need. The doctor may use an ultrasound or other imaging technology to locate your liver. A local anesthetic will be given in the area of the liver. A small incision is made near the rib cage. The biopsy needle will enter the point of incision to collect a sample of tissue from your liver. Often several samples are taken. You will be asked to hold your breath each time the biopsy needle is inserted for sampling. After the procedure, you will need to lie on the right side of your body for two hours to prevent bleeding.
Transvenous Liver Biopsy
A transvenous liver biopsy is used in cases in which there is a risk of blood clotting problems or if an individual has ascites. During the procedure, you will lie on a special X-ray table. You may have an IV to supply you with a sedative and any pain medication you may need. Local anesthesia will be given in your neck, where the incision will be made. Once the incision is made, a special hollow tube called a sheath will be sent down toward the liver. A contrast material, a special dye for X-rays, is injected into the sheath. The contrast material will help highlight the sheath to assist in the biopsy. The biopsy needle is then inserted into the sheath to collect the liver tissue sample. Sometimes the collection of multiple samples is necessary, requiring the consecutive insertion of multiple needles. Once all of the samples have beentaken, the sheath is carefully removed and the incision point is affixed with a bandage.
Laparoscopic Liver Biopsy
When the risk of cancer or an infection is present, a doctor may choose to perform a laparoscopic liver biopsy. A laparoscopic liver biopsy is helpful when multiple areas of the liver, or a very specific location on the liver, require sampling. This biopsy requires creating a few small incisions to accommodate a small lighted camera, a biopsy needle, and a cannula(an instrument to fill the abdomen with gas). Filling the abdomen with gas allows the doctor a greater range of motion to perform the biopsy. A needle is inserted into the cannula and the liver to collect tissue samples. Multiple samples may be needed. The camera can help identify any unusual bleeding. After collection, all tools are removed and the incisions are closed with dissolvable stitches.
After the Procedure: All Biopsy Methods
- After the procedure, you will be taken to a room to rest. While there, your breathing, blood pressure, and pulse will be monitored.
- You will be monitored for 2-4 hours.
- You will need an adult to accompany you from the hospital or clinic to your home. Due to the sedatives, you will not be able to drive.
- You may feel soreness and discomfort around the incision sites for 3-7 days after the procedure.
- Avoid lifting anything in excess of 10 pounds, exercising, or overexerting yourself for a couple of days after the biopsy.
- You should feel ready to resume normal activity within a couple of days.
- Contact your doctor before taking any pain medications, including ibuprofen and aspirin.
As with all invasive procedures, there are some risks associated with a liver biopsy procedure. Below is a list of potential risks of a liver biopsy.
Pain at the site of the incision is the most commonly reported complication associated with a liver biopsy. If you experience pain, speak with your doctor about your options.
- Excessive Bleeding
Excessive bleeding can occur after a liver biopsy. You might require hospitalization to control the bleeding.
Infrequently, infectious bacteria may enter the body or bloodstream during a biopsy.
- Unintentional Damage to Neighboring Organs
In very rare incidences, the needle used for the biopsy may mistakenly pierce an organ other than the liver.
Additional Risks Associated with Transvenous Liver Biopsy
A hematoma, an accumulation of blood, may form near the incision site on the neck.
- Temporary Voice Impairment
Your voice may seem hoarse or weak, or may temporarily disappear immediately following the procedure.
- Temporary Nerve Injury
Rarely, this procedure can temporarily affect the nerves of the face.
Liver tissue samples collected in the biopsy are sent to a lab for processing. A pathologist will investigate the samples for any evidence of liver disease. Results from a liver biopsy can take anywhere from a few days to a couple of weeks to be returned. Your doctor will discuss your results with you during a follow-up appointment. If liver disease is present, your doctor will explain and guide you through your treatment options.