Liver Biopsy

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What is a Liver Biopsy?

A liver biopsy is a procedure by which a thin core of liver tissue is obtained for analysis under a microscope. It is probably the oldest of all the procedures done by your gastroenterologist. It is said to have been first performed by Paul Erlich in 1883. The basic technique has been refined since then. These refinements have decreased the risk to a degree that a liver biopsy is commonly done on an outpatient basis.

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Who needs a liver biopsy?

Since liver biopsy is considered the “gold standard” its indications are many and varied. The clinician uses the information obtained to guide his treatment or assess the extent and severity of liver damage. Some of the more common indications are:
  • Chronic viral hepatitis like Hepatitis B and Hepatitis C.
  • Unexplained liver enlargement and liver tests.
  • Alcohol induced liver disease.
  • Drug induced liver damage.
  • Space occupying liver lesions like tumors and cancers.
  • Systemic diseases and infections affecting the liver.
  • After liver transplantation for rejection and other complications.
  • Assessment of response to treatment.
  • Storage diseases of the liver.

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How is a liver biopsy done?

Most liver biopsies are done on an outpatient basis i.e. the patient stays in the hospital for half a day. The doctor orders tests to check bleeding and clotting times. Patient’s blood group is known and blood available if needed. All recent medications are reviewed. Aspirin and aspirin like medications should have been stopped. Under full aseptic precautions the right side of the chest is cleaned and numbed using local anesthesia. Breathing techniques are practiced with the patient. Using a long fine needle a core of liver tissue is obtained. The actual process takes only 1-2 seconds. This process is repeated and another specimen obtained. A dressing is applied and the patient lies on his/her right side for about 2 hours and on the back for another 2 hours. After about 4-6 hours a blood sample is drawn. If this sample is similar to the one drawn before the biopsy, no bleeding has occurred and the patient is discharged home. The patient spends the rest of the day resting at home. He/She should not be alone and should have easy access to a phone and a hospital.

Sometimes a liver biopsy is done by a Radiologist using an ultrasound or CT scan to guide the needle (US or CT guided liver biopsy). In patients with a bleeding disorder it can be done by a catheter inserted into a neck vein and advanced into the liver (transjugular liver biopsy). Rarely it has to be done via a tube inserted into the abdomen (laparoscopic liver biopsy). Your Borland-Groover Clinic physician will be able to decide which technique is best for you.

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What are the risks associated with a liver biopsy?

A liver biopsy is by and large a safe procedure. The risk of dying is about 1 in 10,000 procedures. The various reported complications are:
  • Bleeding: This is an uncommon but serious complication. It is usually controlled by observation and blood transfusion, but may require surgery to stop it.
  • Injury to the Gallbladder.
  • Bleeding into the bile ducts.
  • Injury to the kidney and colon.
  • A connection between a vein and an artery called a fistula.
  • Irritation of the covering of the lung or liver (Pleurisy or perihepatitis).

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What happens after a liver biopsy?

The day after a liver biopsy the patient can resume his normal lifestyle. Over the next week the liver specimen undergoes extensive evaluation under a microscope by a pathologist skilled in liver diseases. Special stains (dyes) are used to highlight various aspects of the liver. This result is made available to your gastroenterologist who uses this information for diagnosis, treatment decisions and to assess the prognosis.

This is a brief and simplified overview of a liver biopsy. If you have any questions or clarifications please contact your Borland-Groover Clinic physician who will be happy to discuss it further with you.

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