19 March 2019 What is a liver biopsy? A liver biopsy is a diagnostic procedure in which a small sample of the liver is taken using a special needle (a biopsy needle measuring about 1.5 mm). This sample is used for further evaluation by microscope. Liver biopsy can be carried out in three ways that differ in the approach used for the biopsy needle to reach the liver: Laparoscopic; Transjugular; Percutaneous (the most common). How is a percutaneous liver biopsy carried out? The patient is placed in a supine position (on their back) with the right arm facing upwards and placed next to the head. The biopsy needle is inserted into the right abdominal wall between the bottom two ribs. Before inserting the needle, the doctor will determine the exact site by palpation and percussion and then mark it. After the administration of a local anaesthetic at the site, a small incision is made and the biopsy needle inserted and one or more samples of liver tissue quickly obtained. Is any preparation necessary? The doctor should be informed in advance about any allergies, pre-existing diseases or ongoing medications. In many cases it will be necessary to discontinue or alter medications about a week before taking a liver biopsy. The specific instructions for preparation given by the physician must be followed closely , otherwise it may not be possible to perform the hepatic biopsy or its risks will be increased. How long does it take? Carrying out a percutaneous liver biopsy takes around 30 minutes on average. It is carried out in hospital and the patient is usually discharged after 24 hours. In what situations is it carried out? It is always for the doctor to decide whether there is a need for a particular test, depending on the individual characteristics of each patient and their specific complaints or illness. A liver biopsy may be recommended for the diagnosis of various lesions and diseases that can affect the liver and/or the biliary tract . It usually follows on from other complementary examinations which have inconclusive results or require further clarification . Liver biopsy is also used to determine the stage of liver disease , that is, to determine the degree of evolution of liver damage, for the purposes of providing treatment guidance. In addition to diagnostic purposes, hepatic biopsy can also be used to monitor : The efficacy of liver therapy; Known side effects or toxic effects of liver therapy; The effectiveness of a transplant. Percutaneous liver biopsy: does it have any limitations? Liver biopsy is a procedure that can miss lesions and diagnoses , even when the test is carried out correctly. Liver biopsy may have the following contraindications : Changes in blood clotting; Suspected haemangioma and echinococcosis. Where there is fluid accumulation in the abdominal cavity, liver biopsy should not be performed by the percutaneous route . Are there any side effects, risks or associated complications? On average, recovery from a percutaneous liver biopsy is complete within 1 to 2 days . However, increased sensitivity at the biopsy site may persist for some time. The most common side effect of percutaneous liver biopsy is pain at the site of the biopsy , which disappears within a few hours. Although rare, possible risks and complications include: Bleeding (1 in 500 - 1,000); Perforation of internal organs; Infection; Pneumothorax; Dissemination of cancerous cells; Death (1 in 10 000/20 000). Most complications of percutaneous liver biopsy occur within 24 hours of the procedure . You should contact your doctor if you develop any of the symptoms listed below in the days following a percutaneous liver biopsy: Fever; Persistent pain; Redness or discharge at the site of the biopsy; Chest pain; Breathing difficulty; Dizziness; Nausea; Strong abdominal pain. To reduce the risk of complications it is essential the doctor be informed of allergies, other pre-existing diseases or ongoing treatments. In the days following the procedure, physical activities or strong exertion should be avoided . At the hospitals and clinics of the Hospital da Luz network, there are gastroenterologists who specialise in the diagnosis and treatment of digestive diseases. They can also perform any tests that may be necessary for your condition. This article was written with the support of physicians and other clinical professionals from the Hospital da Luz network . The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
