Liver Biopsy

The liver biopsy procedure is performed to determine what is occurring in a patient's liver.

The biopsy often helps to make a specific diagnosis when the cause of liver disease is unclear and aids in determining the amount of a patient's liver damage. During the biopsy, a small piece of liver is removed (less than 1/5,000th of the liver) that does not affect liver function.

The liver biopsy is currently the best way to determine the amount of liver damage, but it is not perfect. Less than 3% of the time, the liver biopsy underestimates the amount of inflammation or scar tissue. Less than 1% of the time, the liver biopsy overestimates the amount of liver damage. Your doctor may wish to advise a liver biopsy one to five years in the future to confirm the original biopsy and document progression or lack of progression of your liver disease.

A percutaneous liver biopsy is the most common. During this procedure, a needle is inserted through the skin on the right-hand side of the chest and a small piece of liver is removed for examination. The biopsy is commonly preceded by an ultrasound examination of the liver (a device to picture the liver using sound waves) to determine the best and safest biopsy site. Not all doctors order an ultrasound before the biopsy procedure. Intravenous sedation can be given at the patient's request (Valium or Versed). Sedation is used to relax the patient, although it is important for the patient to be partially awake so the breathing cycle can be held during the biopsy process. If a patient receives sedation for the liver biopsy, a friend must provide a ride home.

If the patient is from outside San Francisco (more than a two-hour drive), an overnight hotel stay in the city is requested. The entire procedure takes about five hours.

The benefits of a liver biopsy may include:

  • Determination of the severity of liver disease (inflammation);
  • Determination of the amount of liver scar tissue (cirrhosis);
  • Diagnosis change or finalization regarding the cause of liver disease if the blood tests and other assessments are confusing;
  • Recommendation for treatment with interferon (for patients with hepatitis, if cirrhosis if found);
  • Establishment of a screening process for liver cancer if you have cirrhosis;
  • Determination if you have a medication-induced liver disease.

    • The risks of the liver biopsy include:

  • Bleeding (occurs in one out of 500 patients)
  • Bleeding to such a quantity that a patient may require transfusions or surgery (ocurs in one out of 2,000 patients)
  • Death (occurs in one out of 9,000 patients)
  • Puncture of the lung, gallbladder, kidney or intestine (occurs in one out of 3,000 patients)
  • Pain (occurs in one out of five patients)

    • The alternatives to a percutaneous liver biopsy include:

  • No procedure
  • Laparoscopic biopsy (insertion of a tube into the abdomen)
  • Surgical biopsy, with an opening of the abdomen
  • Radiographic biopsy, either with CT, ultrasound or fluoroscopy
  • Transjugular liver biopsy

    • If pain occurs after the procedure, pain medication will be given orally or intravenously if there is no major change in blood pressure or breathing patterns.

    You may be asked to stay in the hospital overnight if there are changes in your blood pressure or abdominal exam that suggest bleeding or another problem.

    Do not take aspirin or non-steroid anti-inflammatory drugs (NSAID) (ibuprofen type) medications one week prior to or following the liver biopsy.

    Visit the Healthwise Knowledgebase for more information about Percutaneous Liver Biopsy