Our Summary

This research paper is about a procedure for measuring the pressure in the veins of the liver (hepatic venous pressure gradient or HVPG) and taking a small sample of liver tissue (transjugular biopsy) in patients with severe chronic liver disease.

The procedure is done under local anesthesia and involves inserting a small tube (catheter) into a vein in the neck, guided by ultrasound. This catheter is then moved into a large vein in the liver, using X-ray images for guidance. The catheter has a small balloon on it that can be inflated to block the flow of blood, allowing for pressure measurements. The difference between the pressure measurements taken when the vein is blocked and when it’s open is called the HVPG. If the HVPG is 10 or higher, it indicates that the patient has significant liver disease.

After these measurements are taken, a small tissue sample from the liver can be obtained through the same tube. This is done by threading a special needle through the catheter and into the liver. The needle can either suck up a small amount of liver tissue (aspiration biopsy) or cut out a small piece of tissue (core biopsy).

The entire procedure takes about 30 to 45 minutes and can provide valuable information about the state of a patient’s liver disease. The researchers note that there are different types of needles that can be used for this biopsy and that the choice may depend on the specific circumstances of the patient’s liver disease.

FAQs

  1. What does a HVPG score of 10 or higher mean in relation to liver disease?
  2. How is the procedure for measuring the hepatic venous pressure gradient (HVPG) and taking a liver biopsy performed?
  3. How long does the whole procedure of measuring HVPG and taking a liver biopsy take?

Doctor’s Tip

One important tip a doctor might give to a patient about liver biopsy is to follow any instructions given regarding fasting before the procedure. It is common for patients to be asked to fast for a certain period of time before the biopsy to reduce the risk of complications. Additionally, it is important for patients to inform their doctor of any medications they are taking, as certain medications may need to be adjusted or temporarily stopped before the procedure. Following these instructions can help ensure a safe and successful liver biopsy.

Suitable For

Patients who are typically recommended for a liver biopsy include those with:

  1. Severe chronic liver disease, such as cirrhosis or hepatitis
  2. Suspected liver cancer or other liver tumors
  3. Abnormal liver function tests that cannot be explained by other tests
  4. Monitoring the progression of liver disease or response to treatment
  5. Determining the cause of liver disease, such as infection or autoimmune disorders

It is important to note that liver biopsy is a invasive procedure and carries some risks, such as bleeding or infection. Therefore, it is typically recommended for patients who have a clear clinical indication and when the benefits of the procedure outweigh the risks. Patients with severe coagulopathy or ascites may not be suitable candidates for liver biopsy. It is important for healthcare providers to carefully assess each individual case and determine if a liver biopsy is necessary for the patient’s management.

Timeline

Before the liver biopsy, the patient will undergo a physical examination and medical history review to determine if they are a suitable candidate for the procedure. They may also undergo blood tests, imaging studies, and other diagnostic tests to assess the severity of their liver disease.

After the liver biopsy, the patient will be monitored for a few hours to ensure there are no complications, such as bleeding or infection. They may experience some mild discomfort or pain at the biopsy site, which can be managed with over-the-counter pain medications. The patient will be advised to avoid strenuous activities and heavy lifting for a few days to allow the liver to heal.

The tissue sample obtained from the liver biopsy will be sent to a laboratory for analysis. The results of the biopsy, along with the HVPG measurements, will help the healthcare team determine the extent of the patient’s liver disease and guide treatment decisions. The patient will have a follow-up appointment with their healthcare provider to discuss the results and develop a treatment plan.

What to Ask Your Doctor

  1. What are the risks and potential complications associated with a liver biopsy?

  2. How will the results of the liver biopsy impact my treatment plan for my liver disease?

  3. Will I need to make any special preparations before the liver biopsy procedure?

  4. How soon will I receive the results of the liver biopsy?

  5. What type of needle will be used for the liver biopsy and why?

  6. Will I experience any pain or discomfort during or after the liver biopsy procedure?

  7. How long will it take for me to recover from the liver biopsy?

  8. Are there any restrictions on my activities following the liver biopsy?

  9. What signs or symptoms should I watch for after the liver biopsy that may indicate a complication?

  10. Are there any alternative tests or procedures that could provide similar information to a liver biopsy?

Reference

Authors: Reiberger T, Schwabl P, Trauner M, Peck-Radosavljevic M, Mandorfer M. Journal: J Vis Exp. 2020 Jun 18;(160). doi: 10.3791/58819. PMID: 32628153