Individuals with suspected liver disease typically require a biopsy (tissue sample) in order to aid the diagnosis process. For example, if cancer is a concern, only a biopsy can reveal the kind of tumor and its stage. Most liver biopsies are performed using a needle that passes through the skin (percutaneous) and into the liver to remove the tissue sample. However, for patients with significant complications of disease, a transjugular biopsy may be recommended. A transjugular biopsy uses a hepatic vein as the channel to the liver as a safer approach for taking the tissue sample.
Why a Transjugular Liver Biopsy is Performed
A patient presenting with symptoms of fatigue, weight loss, jaundice, and abdominal swelling will likely have a blood test to measure overall liver function. If abnormal results point to an issue with the liver, imaging is the next step. While a scan can help confirm the presence of liver disease, only a biopsy can point to the exact diagnosis. A transjugular liver biopsy is a less invasive approach that may be recommended for patients with:
- Ascites (the accumulation of fluid in the abdomen)
- Bleeding disorder (clotting issues)
- Anatomical issues (for example, a small liver)
The major benefit of transjugular liver biopsy, compared to the standard approach, is that any resulting bleeding will happen within the venous system (where it can be easily reabsorbed) and not affect any organs or body tissue as internal bleeding.
What to Expect During a Transjugular Liver Biopsy
A transjugular liver biopsy is performed by an interventional radiologist. The first step is locating the jugular vein in the neck with the assistance of imaging. From here, local anesthesia is applied to the appropriate spot on the neck. After a small incision is made, a catheter (thin plastic tube) is inserted into the vein and threaded through to a large vein in the liver. X-ray imaging with contrast (dye) helps illuminate the vein system and guide this process with accuracy. Once the catheter reaches the liver tissue, the tissue sample is taken. This process may create a sensation of pressure in the patient’s neck and abdomen.
Once the catheter is removed, pressure is applied to the neck to stop any bleeding. Stitches are not needed. The entire procedure should take less than one hour, with another one to two hours of recovery time.
Risks and Benefits of a Transjugular Liver Biopsy
A liver biopsy is a safe, commonly performed procedure that rarely leads to complications. The major benefit of the transjugular biopsy approach is that it limits any internal bleeding. However, since the goal of the procedure is to access a major organ, issues like infection, pain, and discomfort are possible. A percutaneous biopsy (the standard approach through the skin) carries these risks as well, at a higher rate.
Infrequently, the following may occur following transjugular access:
- Pooling of blood called a hematoma. This may happen in the neck, at the catheter incision site, and lead to swelling.
- Lung puncture. If the needle knicks the patient’s lung, there is a chance that the lung may collapse (called a pneumothorax).
- Temporary nerve damage. If a facial nerve is hit during the procedure, there can be short-term issues such as eye drooping or other muscle paralysis (palsy).
How to Prepare for a Transjugular Liver Biopsy
Since a transjugular liver biopsy is an outpatient diagnostic procedure, there is not a lot of preparation required. The care team will consult the patient about the need to pause any medications (such as blood thinners) ahead of the procedure. Instructions around when to stop eating and drinking prior to the appointment will be provided as well. Because transjugular liver biopsy is performed under conscious sedation, patients should arrange for a ride home afterwards and will need to rest the remainder of the day.
Post Transjugular Liver Biopsy
Patients are required to stay in the hospital to recover for a few hours prior to being released home. Patients may feel discomfort at the incision site but should be back to normal daily activities within three to five days. Once the cells from the biopsy are identified and a diagnosis is determined, the patient’s liver specialist will follow up with the recommended treatment plan.