What is a liver biopsy and when is it performed?

By Cristiano Antonino On Jan 31, 2023

A liver biopsy is an examination based on taking a small portion of liver tissue, which is then tested under a microscope

It can be performed percutaneously (tissue sample is taken by a needle inserted through the skin); transvenously (by inserting a catheter through the jugular vein); during abdominal surgery.

What is a liver biopsy used for?

Liver biopsy is used to diagnose acute and chronic liver diseases.

It enables a diagnosis to be made and any doubts about the cause of the disease to be clarified, and allows the severity of the disease to be judged and its progression to be predicted.

It can also be used to assess the effectiveness of treatment.

In the days leading up to the test, the doctor may request that you stop taking certain drugs that could interact with the test.

Medications that may be required to be discontinued include antidepressants, anticoagulants, antiplatelet agents, high blood pressure medication, antibiotics, anti-asthmatic drugs, and NSAIDs.

The patient must have been fasting of both solid and liquid food for at least six hours before undergoing this test.

The patient may undergo a blood test to determine his or her coagulation capacity and, if the need arises, may be given coagulation drugs.

Who can take the test?

Anyone with chronic or acute liver disease can undergo the test.

The main contraindications to liver biopsy are: the presence of ascites (the transjugular route is preferred); obesity; the presence of blood clotting values below normal; if the patient complains of abdominal pain due to gallbladder disease, pancreatitis or intestinal obstruction.

Is a liver biopsy painful or dangerous?

While it can be said that the liver biopsy is a test with a high safety margin and that it does not pose any particular risk to the patient, its nature as a rather invasive test cannot be overlooked.

While serious complications are rare, some minor complications are rather frequent. These include postoperative pain, which can affect 1 in 3 patients (pain can occur at the injection site and extend to the right shoulder) and bleeding.

Complications are rarer today than in the past thanks to the ultrasound-guided biopsy and new needles that are smaller in calibre and less traumatic.

How does the liver biopsy work?

To perform the liver biopsy, the patient must be positioned supine.

The doctor will disinfect the skin at the needle entry point and administer local anaesthesia.

The method involves ultrasound, which allows the doctor to monitor the needle’s route.

The biopsy needle – capable of taking a portion of tissue 2-4 centimetres long – will be inserted and removed quickly.

After the biopsy, the patient should remain lying down, with an ice bag over the biopsy site, for at least 3 hours, and it is recommended that he or she remain at rest for at least the first 24 hours after the test.