What is a Liver Biopsy?

Helpful in the diagnosis of various liver diseases, a liver biopsy is a medical procedure whereby tiny specimens of liver tissue are taken. They are then sent to a medical laboratory where a thorough examination can be completed by looking at the tissue under a microscope.

A liver biopsy is performed to diagnose and monitor diseases that affect the liver and bile ducts. In most cases, a biopsy can provide a very specific diagnosis.

In addition, once a course of treatment for liver disease has begun, liver biopsies help doctors to monitor the effectiveness of various therapies, as well as indicate whether or not certain therapy types are causing damage to a patient’s liver.

Liver Biopsy Methods

Several methods are used to obtain liver samples including laparoscopic liver biopsy, percutaneous image-guided liver biopsy, transjugular liver biopsy, and EUS guided liver biopsy.

1. Laparoscopic Liver Biopsy

A laparoscope is a magnifying telescope that allows an excellent view of the liver’s surface. Using trocars (shafts with three-sided points), small incisions are made in the abdomen to enable insertion of the laparoscope, which sends images of the liver to a monitor.

Using the monitor to facilitate viewing, the physician uses instruments within the laparoscope to remove tissue samples from one or more parts of the liver.

This type of biopsy is used when samples from specific parts of the liver are required.  Most often, this is done during a laparoscopic surgery for another reason – like gallbladder removal.

2. Percutaneous Liver Biopsy

In a percutaneous (passing through the skin) liver biopsy, patient cooperation is vital. A local anesthetic is first administered to numb the area on the body’s right side.

The physician then makes a small incision near the rib cage, and inserts a special biopsy needle to retrieve liver tissue samples.

In some cases, the physician may use ultrasound CT scans of the liver to help guide the needle to a specific spot. This biopsy method is often used when the disease process is localized to discrete spots in the liver.

3. Transjugular Liver Biopsy

With this method, a radiologist inserts tools through a blood vessel, typically in the neck and passes them down towards the liver.  Biopsies can be obtained by passing a needle into the liver tissue from the blood vessel.  This is often used when pressure measurements are needed in the liver vessels.

4. EUS Guided Liver Biopsy

EUS, or endoscopic ultrasound, is a procedure performed by a gastroenterologist in which a scope is passed through the mouth and esophagus into the stomach and beginning of the small intestine where the liver can be visualized with the ultrasound probe.  

A needle is able to pass through this scope and take biopsies of the liver by crossing through the wall of the stomach or small intestine to obtain tissue.

Liver biopsies are performed to help diagnose the following when the diagnosis is not clear based on history, lab work and imaging:

  • Alcohol liver disease
  • Alpha-1-antitrypsin deficiency
  • Autoimmune disorders of the liver and bile ducts, such as autoimmune hepatitis
  • Biliary tract obstruction/jaundice
  • Cancers originating in the liver
  • Cancers that spread (metastasize) to the liver from other sites
  • Chronic hepatitis B or C
  • Drug induced liver injury 
  • Elevated liver enzymes of unknown cause
  • Fibrosis
  • Hepatomegaly (liver enlargement) of undetermined cause
  • Metabolic liver disease such as hemochromatosis and Wilson’s disease
  • Non-alcoholic fatty liver disease (NAFLD)
  • Non-cancerous tumors in the liver
  • Primary biliary cirrhosis
  • Primary sclerosing cholangitis

Liver biopsies are used to monitor the following:

  • A variety of uncommon liver disorders, like autoimmune hepatitis
  • Liver transplantation (to rule out rejection or infection)

Liver Biopsy Preparations

It is vital to compile a list of your current medications, and review them with your health care provider prior to a liver biopsy. Include all over-the-counter medications, herbs, and vitamins.

You will be instructed to avoid medications that may increase the risk of bleeding such as:

  • Aspirin or aspirin-containing medications
  • Non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen
  • Anticoagulants such as warfarin, apixaban, or rivaroxaban 
  • Antiplatelet drugs like clopidogrel or ticagrelor
  • Various herbal remedies such as fish oil and ginkgo biloba

Your health care provider will perform blood tests to confirm your blood clotting capacity is normal.

In some cases, an ultrasound is carried out, examining your liver and gallbladder to determine the best biopsy site.

You will be advised not to eat or drink anything for about eight hours prior to the biopsy.

It is necessary to arrange post-biopsy transportation as sedatives are often administered.

Liver Biopsy Complications

Discomfort – lasting for less than twenty-four hours – at the biopsy site, right upper abdomen, or right shoulder is experienced by 25% of liver biopsy patients.

And though complications are rare – experienced in only 2-3% of biopsies – it’s important to familiarize yourself with the signs and symptoms of liver biopsy complications.

  • Abdominal swelling or bloating
  • Blood in the stool or vomiting blood
  • Chest pain
  • Discharge, pain, redness, or swelling around the needle insertion sites or incisions
  • Dizziness or fainting
  • Fever
  • Nausea or vomiting
  • Shortness of breath
  • Worsening abdominal pain

If you are experiencing any of these symptoms after your liver biopsy, it is best to consult your doctor as soon as possible.

You may also be interested in these other articles on the liver:

Written and Medically Reviewed By

  • Sheila Jennings

    Sheila Jennings is a 4th-year medical student and also freelances as a content writer on gut health, nutrition, and food. She lives with IBS and has learned how to keep her symptoms at bay through a healthy diet and exercise. She wants to educate others on what they can do to take back control of their gut health and live like they used to.

  • Julie Guider, M.D.

    Dr. Julie Guider earned her medical degree from Louisiana State University School of Medicine. She completed residency in internal medicine at the University of Virginia. She completed her general gastroenterology and advanced endoscopy fellowships at University of Texas-Houston. She is a member of several national GI societies including the AGA, ACG, and ASGE as well as state and local medical societies.