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As a Hepatologist (liver specialist) and Gastroenterologist, Dr. Galati is trained to perform a wide range of procedures.  

Liver Biopsy

Indication

A liver biopsy is performed in many situations where direct inspection of the liver tissues is required. Any elevation of liver chemistries, also known as hepatitis, is one of the most common indications. Once the specimen is obtained, it is processed in a number of different ways, allowing for specific testing. After the specimen is received and preserved, and variety of stains are used by the pathologist to test for different conditions. The majority of interest is in visualizing the extent of inflammation and scar damage. Additionally, special stains can be used to detect an accumulation of iron, copper, or fat. All of this information adds to the value of the biopsy.

In patients with chronic hepatitis C, the liver biopsy adds very valuable information regarding the extent of damage the liver has experienced, as well as prediction to some extent the future response to anti-viral therapy. It has been established that patients with hepatitis C with liver biopsies showing increased fibrosis (scarring) or cirrhosis, are statistically less likely to respond to therapy, compared to those with less scarring.

Preparation

Prior to a liver biopsy, you need to avoid all aspirin containing medications, and non-steroidal anti-inflammatory drugs (NSAID’s) , which include ibuprofen, Motrin, Advil, Aleve, and Naproxen. These drugs reduce the effectiveness of your platelets, the blood cells responsible for proper clotting. These drugs will need to be discontinued a minimum of three (3) weeks prior to your procedure. Also, blood thinners such a warfarin (Coumadin), Plavix, and heparin will need to be discontinued. Kindly make these medications known to our staff prior to any procedure. If you have questions, contact our office.

Procedure (Percutaneous Approach)

All food and beverages are stopped at midnight the day of the procedure (NPO). In most cases, it will OK to not take your morning medications. Diabetic patients will need to receive special instructions on their insulin dosing prior to the procedure.

Upon arrival to the outpatient and patient registration areas, you will be taken to the “pre-op” area, where you’ll be greeted by a nurse, who will review your medical history, medications, and questions you may have prior the procedure. The nurse will also review the informed consent for the procedure you will need to sign. Because anesthesia will be used, a small intravenous catheter will be placed.

You will be moved on stretcher to the procedure room, where you will continue to be monitored. Your blood pressure, heart rate, oxygen saturation, and respiratory status will be monitored continuously. Dr. Galati will administer anesthesia, consisting of Demerol, Versed, or propofol. This type of anesthesia is called “conscious sedation”. If you have a prior allergy to these medications, other similar medications will be substituted.

The area of the liver will be marked with the assistance of an ultrasound machine. The biopsy is generally obtained from the right flank, at the level of the breastbone. The skin is cleaned with betadine and covered with sterile towels. Lidocaine, a local anesthetic, is used to numb the skin for added comfort.

A special needle is used to obtain the biopsy. It is called a Klatskin needle, named after the famous liver pathologist Dr. Gerald Klatskin. Once the proper position is identified and confirmed with ultrasound, a small nick in the skin is made, and the needle is gently inserted approximately two inches, recovering a core specimen. A small bandage is placed over the skin, and you will lie flat for approximately one hour.

You remain in bed for a total of four hours. You can have clear liquids two hours after the biopsy in most cases, and resume your regular diet upon discharge. In most situations you will be able to return to work the next day. Because you received anesthesia, you will not be allowed to drive a motor vehicle or operate machinery until the following morning. Specific instructions you will need to follow will be given to you before you are discharged home the day of the procedure.

Complications

The greatest of care is taken to reduce any complications, but still they may occur. Bleeding is the most serious complication associated with a liver biopsy. Serious bleeding occurs in approximately 1 in 10,000 biopsies. Other complications include pneumothorax (air in the lung space) and rupture of the gallbladder. The use of ultrasound to assist in the location of the liver biopsy site has made these complications essentially unseen any more. Nearby loops of intestine can be punctured, but this is rarely seen when ultrasound is used. As with any procedure, infection is possible but very rare. Sterile instruments are used, and the skin is cleaned with betadine solution. If you have fever, an ongoing infection, or a bacterial infection involving the liver, the biopsy will be rescheduled due to the increased risk of spreading the infection to the liver.

Transvenous Liver Biopsy (Transjugular)

This liver biopsy procedure is performd in the radiology suite of the hospital, performed by a radiologist. 

A transvenous liver biopsy is a medical procedure used to obtain liver tissue samples for diagnostic purposes, particularly when traditional percutaneous liver biopsy methods are not feasible or safe. This technique involves accessing the liver via the venous system, typically through the jugular vein in the neck, and utilizing imaging guidance, such as fluoroscopy or ultrasound, to navigate to the liver. The procedure is usually performed by interventional radiologists and is typically indicated for patients with coagulopathy, ascites, or other conditions that increase the risk of bleeding with conventional biopsy methods.

During the procedure, the patient is typically placed under local anesthesia and sedation to ensure comfort. A catheter is inserted into the jugular vein and advanced towards the hepatic veins, which drain blood from the liver. Once the catheter is positioned appropriately, a special biopsy needle is introduced through the catheter to extract a small core of liver tissue. The collected sample is then sent to a laboratory for histopathological analysis, which can help diagnose various liver diseases, including hepatitis, cirrhosis, and liver tumors.

The transvenous approach has several advantages, such as a reduced risk of bleeding and complications associated with percutaneous biopsies, especially in patients with underlying liver dysfunction or significant vascular issues. However, it may not be suitable for all patients, and its success depends on the skill of the operator and the specific clinical scenario. Overall, transvenous liver biopsy is a valuable tool in the diagnostic arsenal for evaluating liver pathology, particularly in challenging cases.