A needle is put into the liver through the abdominal or chest wall. A piece of liver tissue is removed through the needle and sent to pathology for testing. More than one piece of liver tissue may be required. The procedure is usually done using local anaesthetic to numb the area, but some people may have a general anaesthetic. In the case of children, the biopsy will be done under a general anaesthetic.
Following the procedure you may need to lie in bed (sometimes on your side) for up to six (6) hours.
Before the Procedure
Regardless of why biopsy has been recommended for you, there are important steps you can take to prepare for and participate in the procedure.
To properly prepare for your procedure, you may need to make certain changes to your daily medication routine.
- If you take insulin or diabetic tablets, consult with your physician about making any necessary changes in you daily regimen.
- You must tell your doctor what drugs you are taking, particularly: Aspirin products, Arthritis drugs, Blood thinners eg. Warfarin (anticoagulants). It may be necessary to stop taking them seven days before your procedure. They may increase your risk of bleeding after removal of a polyp or a biopsy during your upper GI endoscopy by interfering with the normal clotting of your blood. IF YOU ARE TAKING COUMADIN OR HEPARIN, YOU MUST CHECK WITH YOUR PRESCRIBING PHYSICIAN BEFORE CHANGING OR INTERRUPTING YOUR DAILY ROUTINE.
- Certain medications should be continued prior to your upper GI endoscopy. If you take cardiac (heart) or anti-hypertensive (high blood pressure) pills, take them as you normally do with small sips of water
In addition to changes to your medication, you'll also need to:
- Bring a list of all your medications (prescription medications, over-the-counter medications and eye drops) with you on the day of your procedure. You may bring the medication bottles themselves.
- Be prepared to list and describe your ALLERGIES and REACTIONS to any medications.
Tell the doctor if you have: a pacemaker, a joint replacement, heart, lung or other medical conditions that may need special attention .
Preparation for the Procedure
You must not eat or drink anything for at least six hours before the procedure. Ideally you must not eat or drink anything after midnight the night before your procedure. The exception is medication taken with a small sip of water.
During the Procedure
- On the day of your liver biopsy, please come directly to the requested location at your scheduled arrival time and check in with the receptionist. Plan to spend several hours at the unit to allow time for your preparation, your procedure, and your recovery.
- Everything will be done to ensure your comfort. Your blood pressure, pulse, and the oxygen level in your blood will be carefully monitored.
- Before the procedure, a nurse will greet you and assist you with changing into a hospital gown. An IV may be placed in your arm. After being positioned on your back, the biopsy area will be disinfected and a local anesthetic will be administered by the physician to numb the area. The biopsy needle will be passed through your right side about one inch into the surface of the liver. A Band-Aid is then applied to the site. This takes approximately 15 minutes to complete.
- Some patients experience pain at the biopsy site which may require pain medication.
Risks of this Procedure
- Minor complications such as irritation of the diaphragm muscle by the needle or a small amount of blood could cause pain that is often felt in the right shoulder. This may require an injection of pain killer. This happens in about 1 in 5 liver biopsies.
- Serious complications for 1 in 300 to 1 in 1000 people having a biopsy. These complications include:
- Excessive bleeding from the liver. This may need a blood transfusion and/or an operation.
- The needle may damage the gallbladder (if you still have one) or bile ducts. This could result in bile leaking into the abdomen.
- The lung may be pierced causing leaking of air from the lung.
- The needle may puncture the bowel or other organs inside the abdomen. This may need further treatment or surgery.
- The risk of dying with the procedure is approximately 1 in 10 000 liver biopsies.
- The biopsy may not obtain enough tissue and may need to be repeated.
- Children undergoing liver biopsy have the additional risk of a general anaesthetic. The risk of a serious or life threatening reaction to the anaesthetic for a child in reasonable health is about 1 in 15,000 to 10 in 15,000.
After the Procedure
When your liver biosy is completed on an outpatient basis, you will need to remain under observation until your doctor or healthcare team has decided you can return home. Sometimes, admission to the hospital is necessary.