The most commonly used technique for collecting a liver sample is percutaneous liver biopsy. A percutaneous biopsy is usually performed on an outpatient basis. A mild sedative may be given to the patient prior to the procedure. For this method, a hollow needle is inserted through the abdomen into the liver to remove a small piece of tissue. To help find the liver and avoid sticking other organs with the biopsy needle, doctors often use ultrasound, computerized tomography (CT), or other imaging techniques. The patient lies quietly on the back or slightly to the left side. That area of the skin where the biopsy will be done is carefully cleaned. Then, a local anesthetic agent is used to numb the skin and tissue below. At this point, the physician will tell the patient how to breathe. The needle is advanced into and out of the liver. This takes only 1 or 2 seconds. A slender core of tissue is removed with the needle, and is then processed through the laboratory. The entire procedure from start to finish lasts only 15 to 20 minutes.
Recovery: The patient is kept at rest for several hours following the exam. Medical personnel check the heart rate and blood pressure during this time. There may be some discomfort in the chest or shoulder, however, this is usually temporary. Medication is available for this discomfort, if needed. Before being discharged, the patient is given instructions about returning to normal activities and about eating. Activity is usually restricted for a day or so after the biopsy. However, the procedure does not require a long recovery period.
Complications: In most instances, a liver biopsy is obtained quickly with no problems. As noted, there is occasionally some fleeting discomfort in the right side or shoulder. Internal bleeding can sometimes occur, as can a leak of bile from the liver or gallbladder. These problems are rare and can usually be handled without the need for surgery.
Summary:A liver biopsy is a simple, rapid method of obtaining a sample of liver for analysis. It provides important information for evaluating and treating liver disorders. While some complications can occur, they are unusual. The benefits of the exam always outweigh the risk. Early, specific, and effective therapy can often prevent irreversible liver damage.
Transvenous/Transjugular Biopsy
_ In a transvenous or transjugular liver biopsy, a catheter is inserted into the jugular vein and guided via fluoroscopy (live x-ray) to a primary vein of the liver. The biopsy needle is then threaded through the catheter and guided into the liver to gather tissue. Any blood lost from the liver simply returns to the bloodstream, resulting in minimal blood loss.
Laparoscopic Biopsy
A laparoscopic liver biopsy may be done solely for the purpose of obtaining the biopsy specimen or may be part of another operative procedure. Small incisions are made in the abdominal and instruments are introduced through trocars to obtain the biopsy specimens. The laparoscope is a telescope that magnifies the objects it sees and allows excellent visualization of the liver surface. Ultrasound can be used as part of this procedure.