Liver biopsy at Leeds Hospital

Why might I need one?

Your doctor may recommend a liver biopsy if a scan, such as an ultrasound, CT or MRI scan, has shown an abnormality in your liver but hasn't shown the cause. Taking a tissue sample and looking at it under a microscope is often the most reliable way to reach a diagnosis.

A liver biopsy can help diagnose conditions such as:

• fatty liver disease
• chronic hepatitis, including viral hepatitis B or C
• cirrhosis (long-term scarring of the liver)
• liver cancer, or cancer that has spread to the liver from elsewhere
• autoimmune or alcohol-related liver disease

It can also be used to check how a long-term liver condition is progressing, by measuring the level of fibrosis (scarring) in your liver, which helps your doctor plan and monitor your treatment.

What are the benefits of having it?

A liver biopsy gives your doctor detailed information that scans and blood tests alone often can't provide, including the exact type and severity of any liver damage. This helps confirm a diagnosis, guide your treatment plan, and check how well treatment is working over time.

Are there different types of the test?

There are three main types of liver biopsy:

• percutaneous biopsy, the most common type, where the needle is passed through the skin over your liver; this is usually the first choice, as it's the least invasive
• transjugular (or transvenous) biopsy, where the needle reaches your liver through a vein in your neck; this may be used instead if you have a bleeding disorder or fluid in your abdomen, as it carries a lower risk of bleeding
• surgical or laparoscopic (keyhole) biopsy, sometimes done during an operation you're already having for another reason

How do I prepare for the test?

You'll usually have a blood test beforehand to check your blood cell counts and how well your blood clots, since bleeding is the main risk of this procedure.

Tell your doctor if you're taking any medicine that affects blood clotting, including:

• aspirin or clopidogrel
• warfarin or heparin
• apixaban, rivaroxaban or ticagrelor
• arthritis medicines, anti-inflammatory drugs, or dietary supplements

Your doctor will tell you if you need to stop taking any of these, or other medicines, for a while beforehand. If you take metformin and have reduced kidney function, you may need to stop this 48 hours before your appointment; check with your care team.

You may be asked to avoid food and drink for up to 8 hours beforehand, but follow the specific instructions you're given, as these can depend on the type of biopsy and whether you're having sedation.

If you're having sedation, you'll need someone to drive you home afterwards, and you should plan to be at the hospital for several hours in total.

What happens during the test?

1. You'll lie on your back, and the doctor will clean and sterilise the skin over your liver, usually on your right side, under your ribs.
2. They may use an ultrasound or CT scan to find the best spot for the needle.
3. A local anaesthetic is injected to numb the area; this stings briefly before it takes effect.
4. A small cut is made in the skin, and the biopsy needle is passed through it into your liver.
5. You may be asked to hold your breath for a few seconds while the sample is taken; you might feel some pressure or a brief sharp sensation.
6. Two to three samples are often taken.
7. The needle is removed, and a dressing or small plaster is placed over the site.

A transjugular biopsy follows a different route: a small tube is passed into a vein in your neck and guided down to your liver using X-ray images, and the sample is taken through this tube instead.

Sources give different timings: the percutaneous procedure itself often takes around 15 to 30 minutes, while a transjugular biopsy may take closer to an hour in the department.

What happens after the test?

You'll be monitored closely for a few hours afterwards, as most complications happen in this time. Sources give different lengths for this observation period, ranging from about 2 hours up to 7 hours in total, and you may need to lie flat to begin with.

Most people go home the same day, though you may need to stay overnight, particularly after a transjugular biopsy or if you had sedation. You'll need a responsible adult to take you home, and it's a good idea to have someone stay with you for the first night.

It's common to have some pain at the biopsy site, or sometimes in your right shoulder, for a few hours to a few days. This is usually mild and can be treated with painkillers such as paracetamol.

Sources give quite different advice on how long to avoid strenuous activity or heavy lifting afterwards, ranging from 24 hours to around 2 weeks. Ask your care team for guidance specific to your biopsy, and keep the site clean while it heals.

Your results will usually take a few days to around 10 days, depending on the tests needed. You may already have a follow-up appointment booked, or you may need to contact your doctor to arrange one.

What are the risks or side effects?

A liver biopsy is generally safe, but as with any procedure, there are risks. Common, usually mild effects include:

• pain at the biopsy site or in your right shoulder, usually easily treated with painkillers
• a temporary drop in blood pressure, which can make you feel light-headed

Less common but more serious risks include:

• minor bleeding, in up to 10% of cases. This is usually self-limiting and does not require intervention.
• Major bleeding in less than 2% of cases. This may require blood transfusion, radiological embolisation or, very rarely, surgery.
• infection
• a leak of bile, or injury to the gallbladder or nearby structures
• pneumothorax (a collapsed lung), if the needle passes close to the lung
• if the biopsy is for cancer, a small risk that it could spread cancer cells along the needle's path; this is one reason biopsy isn't always used if there's another way to confirm the diagnosis

Overall, life-threatening complications are rare, estimated at around 1 in 1,000 procedures (<0.1%). A transjugular biopsy carries a small amount of radiation exposure and a slightly different set of risks, such as bruising at the neck or, rarely, temporary nerve effects; your doctor can talk you through these.