transvenous biopsy anyone?

[aerolx]

Has anyone here had a liver biopsy done by this method?  I don't have a blood clotting problem, nor do I have any sign of ascites.  My new Hepatologist does them this way so he can also do a direct measurement of portal pressure gradients as well as taking actual samples.  He says that he can get a much better idea of overall fibrosis this way, since fibrosis is associated with restriction of blood flow through the liver.  He enters at the jugular vein.  I'm interested in anyone's experience with this procedure.   BTW I had a conventional biopsy 6 years ago, and was staged at "2-3...early bridging fibrosis".

[eureka254]

An uneventful procedure AND no signs of cirrhosis, a double bonus! :)
Great to hear that your results give you some breathing room to make decisions, and a wedge pressure of 0 is fantastic!  I'm very glad that you found it a worthwhile undertaking.  Best wishes on whatever your decision. ~eureka

[aerolx]

No trace of cirrhosis!  While I've progressed from a stage "2-3" to a full "3" since my last and percutaneous biopsy from 6 years ago, the wedge pressure measurement was "0".  Same as a normal liver.  My Dr. said that he normally makes a recommendation, and then the patient decides whether to wait for the PI's or to start right a way with SOC.  In my case, he said it was split even.  Either way was ok with him, but that he felt I was quite safe, considering disease progression over the past 6 years, if I decided to wait for PI approval.  With a good chance of halving the exposure time to interferon from 48 to 24 wks., and a nearly double svr rate, it was an quick decision.  BTW, this Dr. quoted a 40% svr rate for genotype 1's with SOC.
So, looking back at my initial apprehension over this method of biopsy, and the final result, I have to say that I'm glad that my Dr. insisted on this procedure.  If I'd known only my staging number, it would have been a more agonizing decision.  Don't be afraid of this method of biopsy if it is suggested.   The procedure is well described on several websites.  Just search for "Transjugular liver biopsy"...and remember, you'll wake up, and aside from a slightly sore neck, it will be over.    

[aerolx]

I just got home from the outpatient clinic where I had a transjugular biopsy, and how right you all were.  I experienced no pain what-so-ever, and I hardly remember anything about the actual procedure.  I have an inch and a half bandage on my neck, and even that only feels slightly tender.  All and all this method is much easier to take than a percutanous biopsy, and I certainly had no reason to be nervous about it.  I will head back to the clinic in 12 days for the follow up.  I remain a little anxious about the results, but who wouldn't.  Once more...thanks to you all.  

[aerolx]

Thanks to everyone for your responses.  There's no substitute for the voices of experience, and I do feel better about the whole thing.  I thought this might be so rare that no one would know anything about it.  Glad to be wrong.
  

[Upbeat]

With all the fear associated with the reg biopsy you would think this would be offered to the people that balk at a reg biopsy.  Maybe there are only a few doctors qualifed with this.

[eureka254]

Glad to be of help. When we first heard about the trans-jug method, it definitely sounded alarming, but knowing now about the number of people who have issues with 'standard' biopsy, imho it's a better method, especially for anyone with possible complications of cirrhosis.  Just make sure to ask for the attending radiologist ;).  Hopefully it'll go smoothly for you and you'll get good news... good luck and best wishes. ~eureka

[neptune235]

Yep...I've had one.  I agree, that the procedure was easy to take.  They use conscious sedation (fentanyl + versed) and was painless.  

[aerolx]

Thanks for the reassurance.  I'm going to have this procedure done in a week, and I've been a bit nervous about it.  The hepatologist said it would easy, but then I once had a doctor say "This is going to pinch a little" about another procedure, and it went well beyond the level of a pinch.
I need to make a decision whether to treat immediately, or whether I can wait for Teleprevir + soc to come on line, and he says that probably won't happen till at least the middle of next year, and that if I fail to reach an undetectable level by week 12 on soc alone, then I should still have a better than 50% chance of svr when the new treatment becomes available for use.  What I do right now hinges on the results of this test, and I agreed to do it even though it sounded kind of radical.  Knowledge is power, after all
Thanks again:  aerolx

[eureka254]

My husband has had a transjugular biopsy, and yes, it provides the ability to measure portal pressure, which indeed can help assessment of overall liver status. As fibrosis progresses, the hardening of liver tissue can restrict blood flow and cause portal hypertension, which can in turn can cause further complications, so measuring portal pressures can be useful in the evaluation of liver dysfunction.

As far as the procedure itself, my husband was very anxious about it, but said after the fact that it was a breeze.  He was sedated, such that he didn't remember much, just the colors of the doc's tie-dyed scarf :), and he was home the same afternoon with no ill effects.  Hope that helps, and good luck with your new hepatologist -- so far, sounds like he knows what he's doing.  ~eureka