Liver Biopsy - Procedure, Indications, Purpose & Recovery

A liver biopsy is a procedure in which a small liver tissue sample is removed for examination under a microscope. It helps diagnose and evaluate the extent of liver disease, inflammation, fibrosis, or cancerous cells. 

The test can be performed using different techniques, such as: 

1. Percutaneous: Also known as a needle biopsy, this is the most common type. It involves inserting the needle through the skin.

2. Transjugular: In this method, the sample is obtained by inserting a catheter into the jugular vein in the neck (which carries blood from the head to the upper chest) and the liver. It is primarily used for patients with bleeding disorders.

3. Laparoscopic: It uses a laparoscope and surgical instruments to collect a tissue sample.
   

Anatomy and Physiology of the Liver

The liver is a large, reddish-brown organ in the upper-right portion of the abdomen, just below the diaphragm. It is divided into two primary lobes; a larger right lobe and a smaller left lobe. The liver has over 500 essential functions in the body. Some of these include the following: 

1. Bile Production: The liver cells, or hepatocytes, produce bile, which is collected by a system of ducts that flow into the common hepatic duct. It transports bile to the gallbladder and duodenum (the first part of the small intestine).

2. Blood Supply: The liver has a unique blood supply from two sources. The hepatic artery provides oxygen-rich blood, while the hepatic portal vein carries nutrient-rich blood.

Liver biopsy offers valuable information about the type and extent of liver damage. It is crucial for accurate diagnosis and optimal treatment planning. Conditions that can be diagnosed using this procedure include: 

1. Non-alcoholic Fatty Liver Disease (NAFLD): Excess fat builds up in the liver, often in overweight and obese people 

2. Liver Cirrhosis: Excessive scarring of the liver due to hepatitis, chronic alcoholism, etc. 

3. Autoimmune Hepatitis: The immune system of the body attacks liver cells, causing inflammation 

4. Hepatitis B and C: Swelling and irritation of the liver caused by viral infections 

5. Primary Biliary Cholangitis: Chronic inflammation in the bile ducts

A doctor may recommend this procedure if a patient gets irregular results on other liver tests. It is primarily used to diagnose liver diseases by examining tissue directly under a microscope. The reasons for liver biopsy may be as follows: 

1. Diagnosing liver conditions that cannot be detected with blood tests and imaging studies 

2. Obtaining a tissue sample to evaluate an irregularity found by an imaging test 

3. Assessing the severity and stage of liver disease 

4. Guiding treatment plans based on the results from a biopsy 

5. Monitoring the progress of treatment for liver disease

Patients scheduled for a liver biopsy receive detailed instructions from their hepatologist or gastroenterologist to ensure the procedure proceeds smoothly. The guidelines provided before and on the day of the biopsy include:

Before Liver Biopsy

Individuals have an initial consultation with their doctor to discuss any questions and address concerns. The medical team explains the biopsy procedure, how it’s performed, and what to expect during and after the process. Here’s what one can anticipate during this visit:

On the Day of the Liver Biopsy

On the day of the procedure, patients should arrange for someone to drive them home after the biopsy. Once they reach the hospital, the following is what usually takes place: 

A liver biopsy test is done in a hospital or outpatient centre. The duration depends on the type of procedure performed. While a percutaneous biopsy takes 15 to 30 minutes, a transjugular biopsy takes 30 to 60 minutes. The steps are as follows: 

1. Anaesthesia: For percutaneous and transjugular biopsy, the surgeon inserts local anaesthesia into the site to numb the area. Patients receive general anaesthesia for laparoscopic biopsy. 

2. Final Procedure: Patients are asked to hold their breath as a liver biopsy needle is inserted to extract a tissue sample. However, the exact steps can differ according to the type of test: 

1. Percutaneous Biopsy: One small incision is made in the skin over the liver. The biopsy needle is inserted through this incision directly into the liver. This is often guided by radiology images to ensure accurate placement of the needle.

2. Transjugular Biopsy: A catheter is inserted into the jugular vein in the neck and guided through the veins into the liver. The biopsy needle passes through the catheter.

3. Laparoscopic Biopsy: Small cuts are made in the abdomen, and a laparoscope and other instruments are inserted to take a tissue sample. 

3. Closure: After the sample is taken, the cut is closed with stitches for laparoscopic biopsy. In the transjugular test, the surgical site is covered with a bandage. The patient is positioned on the right side to apply pressure on the liver and prevent bleeding. 

After the biopsy sample is collected, it is sent to a pathology lab. A pathologist examines this tissue under a microscope. 

After the procedure, it is normal to experience soreness at the needle insertion site for up to a week. Patients should follow their doctor’s guidelines to ensure a smooth recovery both in the hospital and at home. 

In-Hospital Recovery

After a liver biopsy procedure, patients are moved to a recovery room, where the nursing staff monitors their vital signs, such as breathing, blood pressure, and temperature. Patients must rest in the recovery room for two to four hours. Once their condition stabilises, they can return home on the same day. 

At-Home Recovery

Recovery after a liver biopsy is generally quick. Most individuals can resume work and normal activities the next day of the procedure. Some recovery guidelines to be followed after the test include: 

1. Rest for 24 hours.  

2. Leave the bandage in place until the next day.

3. Take prescribed medications to manage pain. 

4. Avoid heavy lifting and intense activity for up to one week. 

Follow-up Appointment

The first follow-up appointment is scheduled 1-2 weeks after the liver biopsy. During this visit, the doctor checks the incisions and looks for signs of complications like infection or excessive bleeding. The hepatologist also discusses the biopsy results, explaining what was found in the liver tissue sample. 

The liver biopsy report is available within a week or two after the procedure. Normal results indicate that the patient’s liver tissue is normal. However, if the biopsy shows abnormal results, it may indicate inflammation and fibrosis, fatty liver, Cirrhosis, etc.

The results from a liver biopsy test help guide the course of treatment.

A liver biopsy provides precise and crucial information, making it an indispensable procedure in hepatology. According to a study by Szymczak et al., the overall success rate of percutaneous liver biopsy is 95.3%. The benefits offered by the test are as follows: 

1. Minimally Invasive: A liver biopsy is typically performed using small incisions or needle punctures. This reduces the risk of complications, minimises pain, and leads to a quicker recovery than more invasive surgical procedures.

2. Targeted Sampling: The procedure allows for direct sampling of liver tissue from specific areas of concern identified through imaging studies. This increases the accuracy of the diagnosis.

3. Low Complication Rate: All surgical procedures carry some risk. However, liver biopsies have a relatively low risk of serious complications (1%) like bleeding and infection.

4. Outpatient Procedure: Patients do not require an overnight hospital stay. This helps reduce healthcare costs associated with inpatient care. Moreover, it allows them to return to normal activities quickly.

Liver biopsies are generally considered safe when performed by skilled specialists. The overall rate of serious complications after the test is about 1%. However, like any surgical procedure, it has certain risks, which include the following: 

1. Pain: Mild discomfort at the biopsy site is the most common complication that occurs in 84% of cases.

2. Bleeding: It occurs in approximately one out of every 500 liver biopsies. More severe bleeding is rare, occurring in one out of every 2,500-10,000 liver biopsies. However, in cases of severe bleeding, blood transfusion or surgery may be necessary. 

3. Infection: There is a small risk of bacteria entering the abdominal cavity or bloodstream.

4. Injury to Other Organs: Although rare, the liver biopsy needle may accidentally damage other nearby organs, such as the gallbladder or lungs, during the procedure.

Since the transjugular test involves inserting a catheter down a large vein in the neck, it involves some additional risks, including: 

1. Haematoma (a collection of blood at the site of biopsy)

2. Temporary voice changes

3. Damage to facial nerves, causing short-term issues like drooping eyelid 

4. Pneumothorax (punctured lung)

When to consult a doctor?

After undergoing a liver biopsy, patients should monitor their health for any signs of complications. They should immediately contact their doctor if they experience the following within 72 hours of the test:

1. A fever higher than 101 F or chills

2. Dizziness

3. Trouble breathing or chest pain

4. Abdominal swelling or intense pain

5. Redness, tenderness, or severe pain at the biopsy site or in the chest, abdomen, or shoulder

A liver biopsy is a gold standard diagnostic test for liver diseases. Delaying it can lead to several complications, particularly if underlying liver conditions are left undiagnosed or untreated. The following are the potential risks associated with postponing this vital test:

1. Progression of Liver Disease: Without a timely diagnosis, liver diseases such as fibrosis, cirrhosis, or hepatitis can progress to more severe liver damage or liver failure.

2. Increased Health Complications: A delay in treatment can lead to complications like ascites (fluid buildup in the abdomen) and hepatic encephalopathy (brain dysfunction due to advanced liver disease). These are severe and potentially life-threatening.

3. Worsening of Symptoms: If the diagnosis and treatment are delayed, jaundice, fatigue, and abdominal pain may worsen. This can significantly affect an individual’s quality of life.

Cost of Liver Biopsy 

The liver biopsy cost in India can vary among individuals based on several factors. The price can range between ₹ 3,000 and ₹ 15,000. The average expense is ₹ 10,000. 

Note: This cost is approximate. Please consult HexaHealth experts for accurate and current pricing information. 

Factors that affect the cost of liver biopsy include: 

1. Type of Biopsy: The method used for the liver biopsy can affect cost. Laparoscopic biopsies tend to be more expensive due to the need for general anaesthesia and complex surgical techniques.

2. Healthcare Facility: Prices can vary significantly depending on whether the procedure is performed in a hospital or an outpatient surgery centre. Hospitals are costlier due to the expenses associated with more comprehensive facilities.

3. Location: Expenditure is higher in metropolitan cities than in smaller towns due to differences in cost of living and availability of specialised care. 

4. Surgeon’s Reputation: Experienced specialists may charge more for performing a liver biopsy. 

5. Insurance: The extent of health insurance coverage can significantly impact the patient’s out-of-pocket expenses. Some policies may cover the full cost, while others cover a portion.

A liver biopsy is a vital diagnostic tool that provides invaluable insights into liver health. By obtaining a small sample of liver tissue, this procedure allows doctors to tailor treatment to individual patient needs. Timely and accurate biopsies can significantly enhance patient outcomes.

At HexaHealth, our medical professionals are well-versed in the latest liver biopsy indications and techniques. We support patients throughout the process, from initial consultation to post-procedure care. So what are you waiting for? Contact us today and take a step towards your liver health.