What is a liver biopsy?

A liver biopsy is a procedure in which a small piece of the liver tissue is taken for examination under the microscope. A small needle is placed into the liver to take a tiny bit of tissue that is sent for further testing.

 Why do I need to have a liver biopsy?

A liver biopsy helps your doctor to make a specific diagnosis of a liver condition, as well as to determine the seriousness of the condition. This information will be useful to help guide the treatment of your liver condition. Your doctor will go through in detail with you prior to the liver biopsy why you need it.

 Are there complications to doing a liver biopsy?

As with all medical procedures, there are some complications associated with liver biopsies. Some patients experience some fleeting discomfort in the right side, or shoulder. This usually can be managed with painkillers and resolves quickly.

Rarely, more serious complications can occur:

• Severe pain (2%)
• Bleeding (0.3 – 0.5%)
  
• Puncture of other organs (0.01-0.1%)
  

These complications are rare, and can be usually managed without the need for surgery.

In very rare cases, a liver biopsy can potentially lead to surgery, and even death.

 How is a liver biopsy performed?

A liver biopsy can either be done bedside by the liver specialist or under ultrasound guidance by the radiologist. The liver biopsy is usually performed as an outpatient procedure in the day surgery ward.

 You will lie on your back, and an area of the skin will be targeted with the assistance of an ultrasound. The area of skin is then cleaned, and a local anaesthetic agent is used to numb the skin and the tissue below. At this point, the doctor will tell you how to breathe in and out, and hold your breath. Upon holding your breath, a thin, specially designed needle will be inserted through the skin. It will be advanced in and out of the liver. This will only take one or two seconds. The doctor may choose to give you some medication to be comfortable at this point. The tissue removed with the needle is then sent for processing by the laboratory.

 The entire procedure, from start to finish, lasts only about 15 to 20 minutes.

What will I expect on the day?

You will be admitted to the day surgery ward in the morning. Some blood tests may be done for you, to ensure that it is safe to proceed with the liver biopsy. You will then undergo the liver biopsy as described above.

 Subsequently, you will be monitored in the day surgery ward for four to six hours. During this period, the day surgery nurses will check your blood pressure and heart rate. They will also monitor you for any pain, and may give you some painkillers if needed. You will be reviewed by a doctor after this period of monitoring, and you will be examined prior to discharge.

 The whole process from admission to discharge can take up to 8 hours.

Will there be serious damage to my liver?

As only a small piece of the liver is removed compared to the liver, there will be no serious damage to the liver.

What do I need to watch out for?

Patients are advised to avoid vigorous physical exercises and avoid carrying heavy weights for the next two weeks. A medical certificate will be issued by the doctor to ensure you rest.

 If you feel faint, black out, have palpitations, or have severe pain after you return home, please seek immediate medical attention.

Are there any other alternative approaches to a liver biopsy?

 Another way of doing the liver biopsy is a transjugular liver biopsy. The needle is passed in through a tube placed in a neck vein, and tissue is taken from the liver through the blood vessel.

 The advantage of this is that there is an even lower risk of bleeding, and it is safer for those with abnormal blood clotting.

 The disadvantage is that the tissue available for diagnosis is less, and it may not yield as effective a result. The cost is also higher.

 If you have a high risk of bleeding, your doctor may discuss doing a transjugular liver biopsy instead.

If you have any further questions about the liver biopsy, please do not hesitate to contact any one of our hepatologists.

 For other other specialist endoscopic procedures, and motility and functional investigations, please click here.