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Percutaneous needle biopsy of the liver see. Consequences of liver biopsy

In addition to ultrasound and x-rays, other diagnostic methods are often used to confirm liver disease. If there is a need to take a tissue sample for examination, either a needle biopsy or laparoscopy is used. Today we will look at what it is liver puncture how it is carried out.

Indications and contraindications for taking a puncture

A puncture is most often performed when a tumor is suspected, to confirm its malignancy or benignity, and is also performed for various liver diseases. Among the indications:

Fatty liver degeneration;

Cirrhosis;

Gallbladder diseases;

Diseases of the bile ducts;

Hepatitis;

Toxic liver damage;

Abscess;

Tumor.

In addition to the indications, there are a number of contraindications, in the presence of which the procedure is not performed:

Inflammation of the peritoneum;

Pleurisy;

Inflammation of the diaphragm;

Impaired heart function;

Hemophilia;

Circulatory system disorders. Also liver puncture It is not recommended for cancer patients and for suspected hemangioma.

How is the puncture performed?

The first step will be a survey and a short examination, after which an intravenous catheter will be installed. It is necessary to sign a special form confirming the patient’s consent to the operation. Before this, the doctor, of course, will talk about all the risks and benefits of this procedure. This will be followed by a diagnostic study - ultrasound, which will help determine the puncture site. Only after this will local anesthesia be administered. Using a special puncture needle, a puncture is made in the liver area. The entire operation is performed under the supervision of an ultrasound echoscope. The needle is inserted directly into the liver tissue, so the doctor obtains a tissue sample. This sample is sent to the laboratory for testing.

How dangerous is puncture?

In fact, conducting this research is quite dangerous. That is why it must be carried out by an experienced doctor. Such doctors work in our center. Only with a professionally performed puncture can various complications be avoided:

Damage to internal organs;

Infections;

Internal bleeding;

Inflammation of the peritoneum;

Fistulas.

Preparation for liver puncture

Before carrying out this procedure, you need to prepare. About a week before the puncture, stop taking blood thinning medications. It is not recommended to take aspirin and medications containing it. 8 hours before the puncture, do not drink or eat. You can only take medications that are approved by your doctor. No further special preparation is required, but in any case, consult your doctor on this issue. It is best to get such advice from specialists at our center.

After liver puncture

You must be under medical supervision for 4 hours after the procedure. During this time you cannot go to the toilet. There may be a feeling of discomfort and slight tingling at the injection site, but this goes away on its own after about 2 days. The results of the liver tissue study will be ready within 3 days. Based on the results, the doctor will determine further actions. If treatment or surgery is required, it will be carried out immediately. In order to undergo a liver puncture, you just need to contact our center. Our specialists will do everything quickly and efficiently. After the procedure, the necessary monitoring of the condition will follow, which will avoid possible complications. Only our center uses the most modern diagnostic equipment and employs highly qualified specialists. By contacting our center, you will receive professional, qualified assistance.


What is a liver biopsy


─ a mini-operation that is performed on the body in order to find out about the condition of the organ by examining its small fragment. This is the extraction of liver tissue into light so that a previously made diagnosis can be clarified or a pathology can be detected that could not be seen with X-ray procedures or conventional blood tests. The study is carried out at the tissue and cellular level, and the fragment is also used to identify dangerous bacteria. A biopsy can not only inform the diagnosis, but also show exactly the extent of the problem.

Why is the procedure prescribed?

Many liver diseases, especially at the beginning of development, do not manifest themselves in any obvious way. These may be general symptoms of weakness, poor appetite, and digestive disorders. In this case, the doctor is in a position where even from blood tests it is impossible to understand what is wrong with the body. Often, all kinds of tests do not show the true condition of the liver and the beginning of the development of a life-threatening illness. If you need to find out the intensity and growth of the disease, a biopsy is prescribed. With its help, you can even monitor the improvement after taking medications in order to understand what treatment methods to use next.


Correct information about liver function is obtained as a result of a biopsy. It is prescribed if the patient complains of pain in the right side, his skin is yellow, as well as other symptoms indicating the possibility of hepatitis or cirrhosis of the liver. An appointment for the procedure is made if it is necessary to clarify the indicators during tests or ultrasound. Some deviations are not noticeable even to the “armed” eye: modern devices cannot show all the subtleties down to the smallest detail. Therefore, a biopsy remains the most accurate test that can reveal the details of the disease.

Preparation for the procedure

Before going for the procedure, a person is required to donate blood to check how stable it is in coagulation.
If you are allergic to any medications, have heart disease, colds that affect the lungs, or problems with blood clotting, there is no need to hide these data. The doctor must know all these nuances on which the success of the biopsy depends, as well as the rapid normalization of the body after the procedure. You need to stop taking medications that can cause severe bleeding ─ all risks need to be eliminated as much as possible.

A week before the procedure, you should stop using aspirin as an antipyretic. All medications that treat inflammation should be withdrawn for a time. This issue is resolved with the specialist performing the biopsy. It is he who must inform you how many days in advance you need to stop taking certain medications, as well as when it will be possible to continue treatment with these drugs again. There is no need to decide on your own whether to accept them or not. Everything must happen under the strict supervision of a doctor.

Carrying out the procedure

The biopsy is performed as follows:


Percutaneous biopsy

This type of biopsy is performed very quickly. The place that will be pierced is made insensitive by injecting anesthesia for local anesthesia: the person remains conscious. But there is no particular pain, and the procedure does not cause suffering to the patient. There are two options for needle insertion:
  • The method is called "blind". Using ultrasound, they look at where to insert the needle so that it hits the right place. But there is no control over the correctness of the hit.
  • There is not only an ultrasound check, but also a CT scan during needle placement.
The results of such a study can show a lot. There is almost a 100% guarantee that this procedure will help identify the smallest deviations from the norm. To ensure that the tissue carries as much information as possible, 1 to 3 cm of material is taken, which will be further studied at the cellular level.

Ultrasound-guided fine-needle biopsy

The skin and internal tissues are first treated with an anesthetic drug to eliminate all pain. Despite the fact that the needle is taken quite thin, it will still be noticeable to a person. This type of study will show not only inflammatory processes, the presence of serious damage due to cirrhosis or other ailments, but also the malignancy of tumors, which at first glance are difficult to determine. For people with cancer, the procedure does not pose any danger, since there is no transfer of negative cells to other tissues of the organ.

This type of biopsy is needed if there is a need to examine not the entire organ, but a small fragment of it. A laparoscope with a camera is inserted into the abdominal cavity, which will display the liver on the screen. The doctor can see the right place, from where he will take the fragment. The study is important when the abdomen is filled with excess fluid for no particular reason, or when there are liver tumors. This procedure cannot be performed under local anesthesia, as it is quite painful. General anesthesia is given.

After completion of the biopsy

After a biopsy of any kind has been performed, the patient should not immediately go home. He is monitored by doctors for at least four hours to prevent complications or side effects that could be dangerous. Also at this time, the patient may experience severe pain and need pain-relieving injections or tablets. After the biopsy, you need to stop driving for half a day.
Do not take aspirin for several days, or preferably a whole week, even if the state of your body forces you to do so. And also do not take those medications that are designed to eliminate various inflammations. You should not overload yourself with physical activity at work, and also give up sports for a while, even if the patient has a habit of it. As for the results obtained as a result of the biopsy, you can find out about them literally a couple of days after the procedure.

Complications

Because biopsy─ this is still an intervention in the normal processes of the body; some complications may arise. If the doctor is inexperienced, there is a possibility of puncturing nearby organs, such as the gallbladder or even the lung.


The liver may begin to bleed, which is why even surgery is performed to eliminate internal bleeding. A biopsy cannot cause death, there is a possibility, but it is very small. Sometimes nausea, fever with fever and pain in the liver occur. In this case, there is no need to hesitate, but you need to urgently tell the doctor about it.

If there is an advanced stage of the disease, then you should not take the risk of performing a biopsy, as this is fraught with serious complications. This can further worsen the patient’s well-being, so the appointment occurs in the most extreme cases.

Trephine biopsy

During trephine biopsy, not just ordinary needles are used, as with an injection, but those that have a special thread. These needles are screwed into the tissue, after which the doctor quickly pulls them out. There are tissues left on the thread that will soon be examined. Now they have created special “pistols” that speed up the process so that the patient does not suffer, and it is also easier for the doctor to carry out this unpleasant procedure.

Indications for use

Since a biopsy is not a painless type of research, it is not always prescribed, but when there is a special need to clarify or clarify the existing diagnosis. Most often a biopsy is performed in the following cases:
  • Finding out details that were not clear during ultrasound or other studies.
  • Determination of all existing causes that indicate the formation of pathology, inflammation, viral disease or the appearance of tumor cells.
  • When you need to find out the exact reasons why the liver has increased in size, as this is a sign of a serious problem affecting the organ.
  • Understanding the causes of strange yellowing of the skin without other symptoms.

Alternative to biopsy

There are now alternative options available such as FibroScan and FibroMax. This is a diagnosis of the liver based on special tests or a more subtle magnetic resonance examination, which shows all the little things and nuances that occur in the liver. These are painless procedures that do not require any special preparation. But these are the most modern types of diagnostics carried out in Israeli clinics. They are quite rare and have a high cost.

A biopsy is a research method in which tissue from an organ is taken with further study of its morphological data. The procedure is considered a rather serious and complex diagnostic method, therefore, before prescribing it, specialists evaluate all indications and contraindications for each specific clinical case.

Liver biopsy is a stage of a comprehensive examination. It is recommended when removing part of an organ in order to differentiate a pathological condition or at the stages of primary and secondary assessment of the patient’s condition if a number of organ diseases are suspected, as well as monitoring the patient over time during therapy.

Indications for the procedure

Most patients believe that a needle biopsy of the liver is performed only if cancer is suspected. This is a misconception. There is a significant list of conditions that are indications for diagnostics:

  • differentiation of malignant processes and benign changes in tissues;
  • detection of metastasis to the liver in oncological processes of other organs;
  • detection of histological signs of cirrhosis, fibrosis, steatosis, etc.;
  • clarification of the severity of the pathology;
  • control over the dynamics of the results of therapy;
  • assessment of the condition of the organ after transplantation.

The study is also carried out in order to exclude the viral origin of the pathological condition. Typically, such a procedure is prescribed if the patient complains of a fever of unknown origin, and a biochemical analysis shows an increase in the level of ALT, AST, and alkaline phosphatase.

Diseases that are indicated for liver biopsy are:

  • viral inflammatory processes of the liver;
  • cirrhosis;
  • hepatosis and steatosis of non-alcoholic origin;
  • hemochromatosis;
  • Wilson-Konovalov disease;
  • Gaucher disease;
  • primary biliary cirrhosis;
  • sclerosing cholangitis.


Accumulation of copper in the hepatocyte zone confirms the presence of Wilson-Konovalov disease

Contraindications

Not every patient is prescribed a diagnosis. There are a number of conditions that are contraindications, since against their background any invasion of liver tissue can be fraught with bleeding and other serious complications. These include hereditary blood diseases (for example, hemophilia), gastrointestinal bleeding, the patient being in a coma, and ascites.

The list of prohibitions and warnings continues with the terminal stages of liver and kidney failure, decompensation of the myocardium and respiratory system, cirrhosis in the decompensation stage, which has arisen against the background of malignant processes.

Diagnosis of hemangioma (benign vascular tumor) does not always allow a puncture biopsy of the liver. The study is carried out only in extreme cases, when histological differentiation of a neoplasm from a malignant process is necessary, since a puncture can provoke bleeding.

Important! The specialist evaluates the pros and cons before prescribing a diagnosis.

Types and methods

There are several basic methods for studying liver tissue, which differ from each other in the information content of the results obtained and in the technique of carrying out the procedure.

Percutaneous biopsy

Percutaneous puncture is usually performed in the morning. The patient is allowed to take a light breakfast. This is necessary so that the volume of the gallbladder is slightly reduced. The procedure is carried out 2-2.5 hours after food enters the body.

The specific device used is the Menghini needle or Tru-cut. During the procedure, the patient lies on his back, the body is slightly bent to the left, and the right arm is thrown back behind the head. The doctor uses percussion to determine the boundaries of the organ and approximately select the biopsy puncture point. Next, an ultrasound machine is used to inspect the area. This is necessary for the specialist to make sure that there are no large vessels in the area, damage to which could cause bleeding.


2 – location of the portal vein, 3 – hepatic artery

  1. The skin is treated with antiseptics.
  2. Local anesthesia is administered. The anesthetic solution is injected in layers.
  3. In the VIII-IX intercostal space, between the anterior and middle axillary lines, a small skin incision is made with a scalpel along the upper edge of the lower rib.
  4. A puncture needle is inserted at the moment when the patient exhales.
  5. The syringe on which the Menghini needle is located should contain a small amount of saline solution. It is pushed out (about 2 ml) at the moment of piercing the fascia, so that the end of the needle is free from nearby tissue.
  6. While the needle is installed on the surface of the organ from which it is necessary to take material for research, the piston is pulled back, creating a vacuum, and the needle itself is pushed at the same time 3-4 cm into the liver tissue, and then abruptly pulled back.
  7. If a Tru-cut type needle is used, its insertion into the tissue is accompanied by the release of a cutting device, with the help of which the biomaterial is collected.

There is another device that facilitates the collection of a piece of organ tissue without disturbing its integral architecture. It is called trephine, and the type of examination is trephine biopsy.

Important! If the liver is huge, the procedure is performed through the anterior abdominal wall. Negative consequences with such access occur less frequently.

The patient should lie down for at least 8-10 hours after the procedure. Be sure to monitor the condition of the organ using an ultrasound machine and the UAC indicators. In some cases, a specialist uses ultrasound, CT or MRI to control the collection of material. Such methods require special needles with notches that are clearly visible on the screen of an ultrasound or CT machine.

Biopsy with local hemostasis

This method is indicated for patients who have bleeding disorders, and other methods of puncture are considered impossible. The procedure is carried out as follows. At the moment of exhalation, a stylet and a needle with a cutting part are inserted into the liver tissue. After a piece of tissue is cut out, it is removed along with the needle, and a special hemostatic solution is injected through the stylet, which, as it were, “fills in” the missing area.


The manipulation kit is selected individually for a specific clinical case.

Transjugular method

The procedure is performed in an angiography room equipped with a defibrillator. The patient is punctured into the internal jugular vein, and a catheter (more than 45 cm in length) is inserted through it. This catheter is passed through the heart and reaches the inferior vena cava. The entire manipulation is controlled using x-rays. A catheter is installed in the liver vein, and a puncture needle is inserted through it. During exhalation, a piece of organ tissue is taken.

Laparoscopic biopsy

It is usually carried out in cases where, during laparoscopic intervention, a tumor was suddenly discovered in the liver tissue. Also, an indication for the procedure is a blood clotting disorder, if the transjugular method is not possible. Laparoscopic biopsy is performed only under general anesthesia.

Possible complications

After a liver biopsy, as after any other invasive intervention, a number of complications may develop. They can develop both in the early period and several months after diagnosis.

Mortality and its causes

There is no reliable data on what percentage of cases resulted in death. Some sources claim that the highest mortality rate within 3 months after puncture is 19%. This figure is inaccurate, since it also includes those clinical cases in which death occurred against the background of terminal stage cancer or liver cirrhosis.

A common cause of death due to complications is internal bleeding. There is also a known case in which the patient died from accidental damage to the gallbladder and the development of further peritonitis due to the outflow of bile into the abdominal cavity. Immediate consultation with a surgeon is necessary if liver puncture provokes the following symptoms:

  • increase in temperature;
  • pain syndrome;
  • lack of intestinal motility;
  • a sharp decrease in blood pressure;
  • pale skin combined with significant sweating;
  • increase in heart rate.

Pain syndrome

Patients often complain that there is pain in the puncture area, discomfort radiating to the neck and shoulder on the right side. Pain syndrome can affect the area around the navel and epigastric zone. The problem is solved by using analgesics, sometimes Atropine.

Subcapsular hematoma

This complication occurs in every fourth patient. As a rule, the doctor detects a problem in the liver tissue by examining the area where the material is taken under the control of an ultrasound machine a day after the manipulation.

Important! The complication is dangerous because there are no symptoms or signs of pathology, since the patient does not have significant blood loss.


To confirm or exclude a subcapular hematoma, not only ultrasound, but also CT and MRI are used

Damage to neighboring organs

They are quite rare. The highly qualified specialist who performs the procedure helps prevent possible complications. However, in clinical practice, cases of punctures of other organs are still known:

  • walls of the large intestine;
  • kidneys;
  • lung with further development of pneumothorax;
  • gallbladder.

Statistics show that these are not all the consequences that a patient can expect. It is known that there have been breakdowns of needles used to puncture the liver, the formation of fistula tracts, and allergic reactions in response to anesthetic drugs.

How to prepare a patient for examination

Before liver puncture, the internal organs must be examined using ultrasound; women are examined by a gynecologist. In addition to general clinical tests, biochemistry and determination of blood group, Rh factor, examinations are carried out for HIV and viral hepatitis.

The attending physician should limit the intake of non-steroidal anti-inflammatory drugs and blood thinners for 7-10 days before the procedure. If the patient suffers from allergies or is hypersensitive to any medications, it is important to inform the doctor. Depending on the choice of method and method of liver biopsy, the last meal should be 2-10 hours before. Before the puncture itself, the patient should be asked to empty his bladder.

Features of the procedure

Before any invasive procedure, the doctor must inform the patient about the need for manipulation and obtain his written permission. The specialist tells the patient about the essence of the diagnosis, its stages, possible complications and results. On the day of the procedure, if the patient is too agitated, premedication is given.

The day before, the patient’s blood type and Rh factor must be checked. Fresh frozen plasma should be available for use if hemodynamic deterioration occurs. Blood clotting indicators are also specified.


If the patient has symptoms of hemorrhagic syndrome, 1.5 liters of plasma should be administered immediately before the start of the intervention

After the procedure itself, a number of patients undergo a course of antibiotics to prevent sepsis and bacterial infection in the area where the biomaterial is collected. Antibacterial therapy is considered mandatory in the presence of heart pathologies and sepsis in the past. The patient is monitored for 24 hours after diagnosis, since clinical studies have proven that in the first 3 hours after the procedure, complications occur in 80% of patients, and within 24 hours - in 90%.

Methods for studying the obtained biomaterial

The material obtained through a biopsy is called a biopsy. He is sent to a laboratory, where he is examined using several methods.

  • Pathomorphological diagnosis– assesses the condition of the cells and tissues of an organ, and is used most often.
  • Biological culture analysis- a method that shows what caused the infection in the liver tissue, determines the type of pathogen, and clarifies its sensitivity to antibiotics.
  • Immunohistochemical method– used to assess the presence of pathological inclusions and deposits of substances in hepatocytes, which is observed, for example, in Wilson-Konovalov disease.

Frequently asked questions

How dangerous is the procedure? – Careful preparation of the patient and adherence to specialist recommendations reduce the risk of complications. If we talk about oncology, a biopsy does not contribute to the spread of tumor cells throughout the body, that is, new metastases do not form due to the procedure.

Is the puncture done on an outpatient basis? – You cannot go home immediately after the biopsy. The patient is under the supervision of a doctor for 6-8 hours, if necessary - up to 24 hours.

How is it done for children? – A child undergoes diagnostics in the same way as an adult. The techniques and methods are similar, anesthesia is selected individually.

Why determine the presence of copper in a biopsy? – This procedure is necessary to differentiate Wilson-Konovalov disease. It is carried out to assess the general condition of the patient and select further therapy.


The specialist will answer all the patient’s questions before the procedure begins.

In the first 10-15 years its widespread use was much greater than in subsequent years.

But based on very solid material (22,675 punctures), it is shown that the average mortality rate for puncture biopsy is 0.16-0.17%.

The following complications of liver puncture were observed: subcutaneous emphysema, internal bleeding, hematoma at the biopsy site, collapsoid state, reflex intestinal paresis), and in all cases the outcome was favorable.

The number of complications decreased especially sharply after the introduction of the Menghini needle into the practice of puncture biopsy. This author, based on the material of 10,000 punctures he performed, did not note a single lethal outcome or a single complication.

In modern conditions, undesirable consequences of liver biopsy, and even more so lethal outcomes, can occur either due to the inexperience of the operator, or when using too large needles, other violations of the puncture technique, or, finally, as a result of ignoring existing contraindications to puncture, which have been sufficiently fully developed.

Contraindications to liver biopsy are based on an analysis of undesirable consequences and the reasons for their occurrence. Therefore, it is necessary to briefly discuss the undesirable consequences of liver biopsy and its complications.

The most dangerous complication of liver biopsy bleeding- subcapsular, into the abdominal and pleural cavities. On biopsy, bleeding occurred in 0.2% of cases. The cause of bleeding can be damage to dilated liver vessels, blood clotting disorders, as well as puncture of liver angioma and echinococcus blisters.

The risk of bleeding increases exponentially with increasing needle diameter. Therefore, after the introduction of needles with a diameter of less than 1 mm into practice, the number of such complications decreased sharply. However, even when using a thin needle, fatal bleeding can occur if the puncture is made into a cavity filled with blood. Thus, Vido, Micek, Langer described a death after a puncture needle entered a cancerous node.

The risk of bleeding also increases when using needles with a pointed end, when the intrahepatic phase of puncture is prolonged, as well as when the patient has blood clotting disorders (hypoprothrombipemia, hypofibrinogenemia, thrombocytopenia, prolongation of blood clotting time and bleeding time), which is known to often occur with prolonged jaundice and severe forms of liver cirrhosis.

In order to prevent bleeding, it is recommended that patients be prescribed vitamins P, C and K before puncture and must determine the main indicators of the blood coagulation system (platelet count, prothrombin index, bleeding time and blood clotting time).

Developed bleeding requires urgent administration of hemostatic agents and, above all, blood transfusion. If symptoms of internal bleeding increase, it is necessary to perform.

The second serious undesirable consequence of liver biopsy is bile and purulent peritonitis, observed in general quite rarely. Most often, biliary peritonitis occurs during puncture of patients with prolonged subhepatic jaundice.

To prevent this complication, in all cases where it is impossible to firmly exclude a biliary tract infection, it is advisable to prescribe before and after puncture; developed inflammation of the peritoneum may require surgical treatment.

A rare and usually transient consequence of liver biopsy is pneumothorax.

Sometimes after a puncture a picture develops pleural shock. Usually the cause of shock is insufficient preparation (psychological and medicinal) of patients. When shock or collapse develops, analgesics, sedatives and vascular drugs are indicated; in severe cases - blood transfusions.

Among the rare consequences of liver biopsy, possible organ punctures- lung, intestines, kidneys, gall bladder.

A common, but not dangerous and transient consequence of liver biopsy is pain. They can be local (in the right hypochondrium) and reflected (in the epigastric region, in the right shoulder or above the collarbone). Most often, pain appears due to poor preparation of the patient, increased excitability, insufficient anesthesia or rough manipulations. No medications other than analgesics are usually required.

The article was prepared and edited by: surgeon

In medicine, biopsy as a diagnostic method is used quite widely. This procedure allows you to thoroughly examine many organs and clarify serious diagnoses. The liver is a leader in conducting such diagnostics.

This is due to the fact that this organ is prone to the development of numerous diseases of various natures. In addition, it is in it that metastases from cancer of other organs quite often settle. And cancerous diseases of the liver itself are far from uncommon.

A liver biopsy is the obtaining of a small fragment of tissue from this organ to make a diagnosis or clarify it. This procedure allows you to accurately identify the causes of the disease, the stage of the inflammatory process, as well as how much the connective tissue has grown with the appearance of scar changes.

Indications and contraindications

Before a biopsy is recommended, the patient must have an ultrasound of the liver as well as a CT scan. If such diagnostic measures do not provide sufficient clarity, then a biopsy will help to understand the remaining questions. As a rule, it is prescribed in the following cases:

  • causeless appearance of jaundice;
  • for the dynamics of treatment for hepatitis C and B;
  • stable deviations in biochemical tests, impaired enzyme function;
  • hepatitis of unknown origin;
  • primary biliary cirrhosis;
  • congenital enzymopathies and abnormalities of liver development;
  • periods before and after liver transplant surgery;
  • if metastases in the liver are suspected against the background of cancer of other organs;
  • confirmation of the presence and prognosis of the course of alcoholic illness;
  • if liver cancer is suspected.

This procedure is carried out only after a thorough examination of the patient by a council of doctors. As a rule, it consists of a hepatologist, an infectious disease specialist and an oncologist.

If there are serious contraindications to a biopsy, the specialist will look for alternative methods

There may be absolute and relative contraindications to such diagnostics. Among the absolute ones we can highlight the following:

  • a history of unexplained bleeding;
  • decreased blood clotting;
  • confirmed liver hemangioma or other vascular tumor;
  • presence of a confirmed hydatid cyst;
  • when it is impossible to determine the location of the biopsy;
  • categorical refusal of the patient from the procedure.

In addition, there are relative contraindications:

  • hemophilia;
  • severe obesity;
  • severe ascites;
  • amyloidosis;
  • infectious diseases of the right pleural region;
  • allergic reactions to anesthetics and analgesics.

This type of diagnosis usually raises a number of questions in patients. One of the main ones is how is a liver biopsy done and is it painful? In addition, patients want to know how to prepare for the procedure and what to expect afterwards.

Preparatory stage

Most often, the procedure is prescribed to patients who are undergoing hospital treatment, so the medical staff will help them prepare appropriately, giving clear recommendations. If the patient is at home, he must follow these steps:

  1. To avoid bleeding, which will be difficult to stop during liver manipulation, you should stop taking blood thinning medications 7 days before the scheduled biopsy.
  2. Take all tests prescribed by your doctor first. For example, a blood clotting test.
  3. 2-3 days before the test, you need to exclude foods that increase gas formation from your usual diet. Enzymes and drugs that reduce flatulence (Unienzym, Espumisan) will help improve the functioning of the gastrointestinal tract.
  4. The last meal before the procedure should be no later than 8 hours.
  5. On the eve of the biopsy, you need to have a good rest and avoid heavy physical activity.
  6. It is prohibited to do thermal procedures, take a hot bath or shower the day before the procedure.
  7. If the patient needs to take some medications daily, then the attending physician should explain what to do in such a situation on the day of the study.

The patient must inform the doctor if he has allergic reactions to medications, heart disease, lung disease, or problems related to blood clotting. This way he will protect himself and help the medical specialist adjust the planned procedure.

Types of biopsy and procedure technique

The main types of this diagnostic method in hepatology are:

  • liver puncture biopsy;
  • transvenous (transjugular);
  • laparoscopic;
  • incisional (open).

Preference for a specific procedure is given strictly individually and depends on the suspicion of a specific disease and the general condition of the patient.


Good communication between the patient and the doctor will help minimize the undesirable consequences of the biopsy.

Needle biopsy

This method is most often used for hepatitis. It can be performed without hospitalization of the patient. Percutaneous puncture biopsy comes in 2 main types:

  1. Blind aspiration. Such a study involves using an ultrasound diagnostic device to determine the location, and then perform the puncture itself blindly. However, this method allows one to obtain less high-quality biological material and increases the risk of complications.
  2. Sighting aspiration. The puncture needle is guided under ultrasound or computed tomography control. This method is considered more reliable and has a lower risk of complications.

The procedure is done as follows:

  • The patient takes a supine position, with his right hand placed under his head.
  • The skin at the intended puncture site is treated with an iodine solution and the skin is infiltrated with an anesthetic just above the lower edge of the lower rib.
  • A skin puncture is made with a scalpel (depth 5 mm) so that the biopsy needle can penetrate better.
  • Throughout the procedure, the patient is asked to hold his breath while exhaling completely.
  • After removing the instrument and the necessary liver tissue samples, the patient should lie for an hour on his right side and another 2 hours on his back. This will prevent bleeding.

It would be good for the patient to be monitored by medical personnel for 10 hours after the liver biopsy, as this is when complications may occur.

Transvenous biopsy

This type of diagnosis is a priority for patients with poor blood clotting and undergoing hemodialysis courses. The procedure involves inserting a thin, flexible tube into a vein in the neck or groin. This tube is inserted into the veins of the liver, after which a sample is taken for testing. The process is controlled by a fluoroscope.

The procedure can last from half an hour to an hour. An ECG must be done during the process, since arrhythmia may occur. Transvenous biopsy is performed under the influence of local anesthetics. During the process, the patient may feel pain along the path of the biopsy tube.

This technique makes it possible to extract a biopsy through the vascular system of the liver, which minimizes the risk of extensive bleeding after the procedure. However, it is contraindicated in Budd-Chiari syndrome (hepatic vein thrombosis).

This diagnostic method is carried out in a hospital operating environment. Where on the stomach, under general anesthesia, a specialist will make several punctures through which a miniature video camera and the necessary set of instruments are inserted. You can control the process through the image on the monitor.


Laparoscopic biopsy is performed using special optical (endoscopic) equipment

In addition to examining benign tumors or other liver pathologies, during this procedure it is possible to excise the tumor with minimal tissue damage. Laparoscopic surgery is optimal for removing cancer or liver cysts. The duration of such manipulation is about 1.5 hours.