Our Summary

In basic terms, this study discusses the procedure of liver biopsy, which is a test done to take a small sample of liver tissue for examination. This test is done when other safer methods fail to provide necessary information about a patient’s condition or for research purposes. There are different ways to do a liver biopsy, but mostly it is done either through the skin or through a vein. The choice of method and the type of needle used depends on the patient’s health condition and the expertise of the healthcare provider.

For non-tumor biopsies, a specific type of needle (16-gauge) is suggested. Patients with liver disease often have abnormal blood clotting tests or are on medications for preventing blood clots or platelets from sticking together. By better understanding how blood clotting changes in liver disease, doctors can better manage patients around the time of the biopsy.

Generally, liver biopsy is safe, but there can be minor complications and, in very rare cases, death. So, it’s important to fully inform patients about the procedure. The tissue sample taken during the biopsy needs to be large enough for the pathologist to interpret. Clear communication between the doctor and the pathologist, about the patient’s clinical information and other test results, is crucial for a useful report.

FAQs

  1. When is a liver biopsy required?
  2. What are the different approaches to liver biopsy and how is the approach determined?
  3. What is the recommended needle size for non-lesional biopsies?

Doctor’s Tip

One helpful tip a doctor might tell a patient about liver biopsy is to make sure to inform them about any medications they are taking, especially blood thinners, as they may need to be temporarily stopped before the procedure to reduce the risk of bleeding. Additionally, it is important for the patient to follow any pre-biopsy instructions given by the healthcare team, such as fasting before the procedure. After the biopsy, the patient should monitor for any signs of infection or bleeding and contact their healthcare provider if they experience any concerning symptoms.

Suitable For

Patients who are typically recommended liver biopsy include:

  1. Patients with suspected liver diseases such as hepatitis, cirrhosis, fatty liver disease, autoimmune liver disease, or liver tumors.
  2. Patients with unexplained abnormal liver function tests or elevated liver enzymes.
  3. Patients with suspected liver metastases or primary liver cancer.
  4. Patients with suspected liver fibrosis or inflammation.
  5. Patients with suspected drug-induced liver injury.
  6. Patients undergoing evaluation for liver transplantation.
  7. Patients with monitoring of disease progression or treatment response in chronic liver diseases.
  8. Patients with suspected liver infections such as hepatitis B or C.
  9. Patients with suspected genetic liver diseases such as hemochromatosis or Wilson’s disease.
  10. Patients with unexplained ascites or portal hypertension.

Timeline

Before liver biopsy:

  • Patient is evaluated by a healthcare provider to determine the need for a liver biopsy.
  • Patient may undergo blood tests and imaging studies to assess the liver function and anatomy.
  • Patient is informed about the procedure, risks, benefits, and alternatives.
  • Patient may be asked to stop taking certain medications that can affect blood clotting.
  • Patient may need to fast before the procedure.

During liver biopsy:

  • Patient is positioned on their back or side on an examination table.
  • The skin over the liver is cleaned and numbed with a local anesthetic.
  • A needle is inserted through the skin and into the liver to obtain a small tissue sample.
  • Patient may feel pressure or discomfort during the procedure.
  • The procedure typically takes about 30 minutes.

After liver biopsy:

  • Patient is monitored for a few hours to check for any complications.
  • Patient may experience mild pain or discomfort at the biopsy site.
  • Patient may be advised to avoid heavy lifting or strenuous activities for a few days.
  • The tissue sample is sent to a lab for analysis.
  • Results are typically available within a few days to a week.
  • Patient will follow up with their healthcare provider to discuss the results and determine next steps in treatment.

What to Ask Your Doctor

  1. What is the reason for recommending a liver biopsy in my case?
  2. What information will be gained from the biopsy results?
  3. What are the potential risks and complications of the liver biopsy procedure?
  4. How should I prepare for the liver biopsy procedure?
  5. Will I need to stop taking any medications before the biopsy?
  6. How long will the biopsy procedure take and will I need to stay in the hospital afterwards?
  7. When and how will I receive the results of the biopsy?
  8. What follow-up care or monitoring will be needed after the biopsy?
  9. Are there any specific symptoms or signs I should watch for after the biopsy?
  10. Are there any alternative tests or procedures that could provide similar information without the need for a liver biopsy?

Reference

Authors: Neuberger J, Patel J, Caldwell H, Davies S, Hebditch V, Hollywood C, Hubscher S, Karkhanis S, Lester W, Roslund N, West R, Wyatt JI, Heydtmann M. Journal: Gut. 2020 Aug;69(8):1382-1403. doi: 10.1136/gutjnl-2020-321299. Epub 2020 May 28. PMID: 32467090