What is a Liver Biopsy?
A liver biopsy is a procedure where a qualified doctor (typically a hepatologist, radiologist, or gastroenterologist) uses a special needle to get a small sample of your liver tissue to examine under a microscope. This liver tissue allows the doctor to see if your liver is healthy or to better understand why you have liver damage or disease and how severe any damage is.
Using the results from the liver biopsy, your doctor will assess:
- The degree of liverinflammationor damage (grade)
- The extent of scar tissue or fibrosis (stage)
- Presence and extent of fatty liver or other metabolic liver diseases
- The cause of abnormal liver tests if not already known
- Occasionally, a guided biopsy is performed of a liver mass or “spot” to see if it is cancer
How is a Liver Biopsy Performed?
There are two main ways to perform a liver biopsy. Your doctor will discuss with you which kind of biopsy is best for you.
The most common way uses a special needle to remove the tissue through a very small incision in the skin along the right chest wall.
Less often, the doctor performs a liver biopsy through a vein in your neck (transjugular approach) or may place the biopsy needle in another location in the abdomen to reach the liver (surgical approach).
What are the Risks of a Liver Biopsy?
Generally liver biopsy is a safe procedure, however some risks include but not limited to the following:
Pain: 1 out of 4 people have pain right after the procedure (usually lasts 5-20 minutes), 1 out of 100 have pain for 1-7 days after the procedure, and 1 out of 1000 have long term right upper abdominal pain after the procedure
Bleeding: The risk of significant bleeding that requires hospitalization and possibly blood transfusion is less than 1 out of 1,000 to 3,000 patients
Bile leak: can occur, however the risk level not known
Perforation of other organs such as colon, kidney or lung: risk far less than 1 out of 1000 because our biopsies are ultrasound guided
Heart or lung problems from anesthesia: less than 1 out of 3,000
Allergic reaction to lidocaine: less than 1 in 3,000
Severe complications such as shock, or something requiring surgery or interventional radiology to treat or stop bleeding or managing bile leak or organ perforation: less than 1 in 6,000
Death: less than 1 in 12,0000
Before the Procedure
- 6 hours before the procedure: stop eating foods or liquids that you cannot see through. OK to drink clear liquids such as apple juice, Gatorade, ginger ale, or water.
- 3 hours before the procedure: Do not drinkanything.
- Your doctor may give you additional instructions for this procedure. Please read them carefully.
- Bring the completed medication reconciliation form and the completed medical history form with you to check-in.
If you wish to be given intravenous sedation and pain medication before and during the procedure, you must arrange for a responsible adult to drive you home after the procedure, or accompany you if you are taking a taxi or public transportation. You will be ready to go home about 3-4 hours from your check in time. You may not drive for 24 hours after the procedure or make any legally binding decisions the rest of the day if you receive intravenous sedation. However,intravenous sedation is not mandatory for liver biopsy procedure. If you wish not to be given intravenous sedation or pain medication (you will be able to receive only Tylenol for pain in such case), you candrive or take a cab home alone after this procedure.
One week before the procedure:
- Stop taking aspirin and NSAIDs (such as Advil, Motrin, Aleve, ibuprofen, naproxen, etc).You may take acetaminophen (Tylenol).
- Stop taking herbal and other supplements such as Fish oil and Ginkgo.
- If you take a blood thinner such as Coumadin (warfarin) or Plavix (clopidogrel), please discuss with your prescribing doctor whetheryou can stop taking this medication prior to the procedure (usually 5 days before).
On the day of procedure:
- If you are diabetic, consult your prescribing physician if you should take or should not take your medication.
- Take other medications that are prescribed to you such as those for high blood pressure, irregular heartbeats, seizures, or pain medications.
On the Day of the Procedure
Please arrive 1hourprior toyour scheduled procedure.
If you wish to be given intravenous sedation and pain medication before and during the procedure, your responsible adult driving or accompanying you home must be present or available by phone when you check in. Not doing so will either result in rescheduling your procedure or not being able to provide intravenous sedation and pain medication.
Bring your insurance information and a list (or the bottles) of medications you are taking including vitamins, over-the-counter medications, and herbal supplements.
The doctor will do an ultrasound immediately before or during the procedure to find the best location near your liver to perform the biopsy.
Signing the consent form: The doctor explains the procedure to you and asks you to sign a consent form stating that you understand the procedure as well as the risks, the benefits and the alternatives to the procedure. This is a good time to ask questions and share any concerns you may have.
Plan to stay for at least 2 hours and for up to 4 hours after your biopsy.
During the Procedure
The Registered Nurse (RN) places an intravenous line (IV) in your arm. The IV allows the doctor/RN to give you medications for your comfort. During this time, the RN may also draw blood if needed.
You are placed on monitors that measure your blood pressure, pulse, and oxygen levels.
The doctor will ask you to lie flat with your right arm above your head. Then your doctor may do an ultrasound to find the best place for the biopsy. Once the liver biopsy site is determined, and will be marked. The doctor cleans the area for the biopsy and injects a local anesthetic around the insertion site. He/she will instruct you on breathing during the biopsy and when to hold your breath.
You may request to be given oral or intravenous sedatives immediately before your procedure after meeting with the doctor. Please notify the scheduling staff and the nursing staff if you would prefer to be given the sedatives to allow for sufficient planning.
What Happens After My Procedure?
After the biopsy, you will have your blood pressure, pulse and oxygen levels checked often. Your nurse will check the biopsy insertion site for any signs of bleeding.
You will be allowed to drink fluids if your condition is stable. However, some patients may be asked not to eat or drink for 2 hours after the procedure.
Your blood may be drawn after the procedure to make sure everything is normal and it is safe for you to go home.
The biopsy insertion site will be covered by an adhesive bandage.
The bandage can be removed after 48 hours at your home by you or your family.
You will receive detailed instructions about how to care for yourself at home from your doctor and the nursing staff.
Do not take any Aspirin or pain medication (specifically any non-steroidal antiinflammatory such as ibuprofen or naproxen) for one week after liver biopsy unless otherwise told by your doctor. Acetaminophen up to 2g/day (Tylenol ES 4 tab) is safe to take. Please do not mix with alcohol and other medication containing acetaminophen.
When you are ready to go home, your nurse will review a copy of your home care instructions with you and with the responsible adult accompanying you for the procedure. These instructions will have any changes in medications and a phone number to contact your doctor.
Call your doctor and go to the closest emergency room if you experience any of the following symptoms:
- Increased pain in the stomach, shoulder, or chest
- Bleeding from the biopsy site that is more than a teaspoon
- Weakness, dizziness, or lightheadedness that effects your ability to stand or walk
- Shortness of breath that is not corrected in less than 2 minutes
- Fever or shaking chills
- Any vomiting of blood or passing blood in your stools
- If you have a new symptom or problem and you cannot reach your practitioner, go to the nearest ER to be evaluated.
* * * The final results of your biopsy are usually available within 7 days. * * *