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LIVER BIOPSY PROCEDURE OPINIONS
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LIVER BIOPSY PROCEDURE OPINIONS

Any opinions about which type of liver biopsy is easier to tolerate??? To read about the procedure, it sounds like the biopsy thru the abdomen would be a better choice than thru the jugular vein...... Am I wrong???
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Hello! I had one about two weeks ago. They hook you up to an IV, give you oxygen. A nurse takes an ultra-sound and marks the point and angle the doctor must inject the probe that will take a small piece of tissue to have test run. When you are prepped and ready the nurse will inject a drug that puts you to sleep for about an hour. Ask what they test for. I’m sure they run a complete screening to test for cancer amongst all other liver stages, etc. Good luck!  
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Annie,

A biopsy is a safe, easy, and pretty painless procedure. I found the pain killer shots more painful then the biopsy itself. Your doc will decide on the type you have. Many of us have had a least one. Percutaneous Liver Biopsy (needle-puncture of the skin) is the most common and simple. Below is info then you probably need to know...

"WHAT YOU NEED TO KNOW: LIVER BIOPSY"
Jayna H. Maxwell

The various methods for performing a biopsy of the liver are as follows:
(1) Percutaneous Liver Biopsy – this type of biopsy is done directly through the skin into the liver. Needles for percutaneous liver biopsy are broadly categorized as suction needles, cutting needles, and spring-loaded cutting needles that have a
triggering mechanism. The cutting needles, except for the spring-loaded variety, require a longer time in the liver during the biopsy, which may increase the risk of bleeding. A greater incidence of bleeding after biopsy has sometimes been observed
with large-diameter needles. If cirrhosis is suspected on clinical grounds, a cutting needle is preferred over a suction needle, since fibrotic tissue tends to fragment with the use of suction needles. This would render the tissue sample less useful or even
useless for diagnostic purposes.
It is now standard practice to perform liver biopsy on an outpatient basis, provided that various criteria are met. The Patient Care Committee of the American Gastroenterological Association has published practice guidelines for outpatient liver
biopsy. The patient must be able to return to the hospital in which the procedure was performed within 30 minutes after the onset of any adverse symptoms. Reliable persons must stay with the patient during the first night after the biopsy to provide
care and transportation, if necessary. The patient should have no serious medical problems that increase the risk associated with the biopsy. The facility in which the biopsy is performed should have an approved laboratory, a blood-banking unit, an
easily accessible inpatient bed, and personnel to monitor the patient for at least 6 hours after the biopsy. The patient should be hospitalized after the biopsy is performed if there is evidence of bleeding, a bile leak, pneumothorax (air or gas in the
pleural space), or other organ puncture, or if the patient’s pain requires more than one dose of analgesics in the first 4 hours after the biopsy.

(2) Transjugular Liver Biopsy – With transjugular liver biopsy, the liver tissue is obtained from within the vascular system rather than directly through the skin into the liver. This minimizes the risk of bleeding. The procedure involves percutaneous
puncturing of the right internal jugular vein located in the neck area, the introduction, with the use of fluoroscopy (a type of xray), of a catheter (a flexible tube) into the right hepatic vein (a major vein carrying blood from the liver), and a needle biopsy
of the liver performed through the catheter. The duration of the procedure is between 30 and 60 minutes. Electrocardiographic monitoring is required to detect arrhythmias induced by passage of the catheter through the heart.
Samples are retrieved from a needle passed through the catheter into the liver while suction is maintained. The samples obtained are small and fragmented, a disadvantage of the technique that may be improved with newer-generation technology.
Adequate tissue for histologic diagnosis can be obtained from 80 to 97 percent of patients in centers where a large number of transjugular biopsies are performed. In various studies, the rate of complications associated with transjugular liver biopsy
ranges from 1.3 percent to 20.2 percent, and mortality ranges from 0.1 percent to 0.5 percent.

(3) Laparoscopic Liver Biopsy – Diagnostic laparoscopy is especially useful in the diagnosis of diseases of the cavities enclosing the stomach and pelvis, the evaluation of ascites (the accumulation of fluid in the abdominal cavity) of unknown
origin, and the staging of abdominal cancer. It can be performed safely under local anesthesia with conscious sedation. However, the use of laparoscopic liver biopsy by gastroenterologists has declined in favor of less invasive radiologic
procedures, and very few gastroenterology training programs now provide instruction in the procedure, which is usually performed by surgeons because of their growing experience with laparoscopic surgery.

(4) Fine-Needle Aspiration Biopsy – Fine-needle aspiration biopsy of the liver is performed under ultrasonographic or CT
guidance. Patients with a history of cancer and liver lesions are good candidates for fine-needle aspiration biopsy. The
diagnostic accuracy ranges from 80 to 95 percent and is substantially affected by the expertise of the pathologist. Cytologic
findings (microscopic examination of the extracted cells) that are negative for cancer do not rule it out. Although ultrasound-guided or CT-guided biopsy is usually reserved for focal hepatic lesions (defined areas of suspicious or
diseased tissue), limited data suggests that diagnostically useful material can be obtained with automatic spring-loaded biopsy
needles guided by ultrasound in over 95 percent of patients, including those with diffuse liver disease (i.e., disease which occurs throughout the liver, such as in hepatitis C). Fine-needle aspiration biopsy is associated with a low risk of seeding of
the needle tract with malignant cells and is generally a very safe procedure.
Source Information: From the Liver Center, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston

Hector
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I had a percutaneous liver biopsy two days ago at my hospital. First they got an unltrasound (ecograph) machine going, applied the probe to my side, and focused on my liver. Then they gave me a local anesthetic: a quick little shot in the skin, then a longer, deeper one in the side of the rib cage. No pain to speak of. Then, watching the ecograph screen the doctor used an automatically (spring-loaded) injected biopsy needle, which liver tissue was aspirated into, moving the needle around a bit to get at different parts of the liver. The whole thing took about three minutes and was virtually painless. Afterwards, I was left to recuperate for two hours lying down. Then the doctor told me I could go home. He said I could go to the gym again in about a week.

It's not a painful procedure, but it is a little scary. After all, they're putting a steel needle through your side and into the middle of you liver. What most bothered me (and bothers me still) is wondering what damage that needle might have done to my liver or the tissues it passed through on the way to my liver. Sticking long, relatively wide needles into a diseased liver doesn't strike me as a very good idea, whether it hurts or not.

But everyone says that biopsy is the way to go. Personally, I remain unconvinced.

Mike
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Avatar_m_tn
I have had 6 or 7 biopsies. I really can't remember for sure because some were shortly after my transplant and were performed in my hospital room and that's rather hazy. My last two biopsies were like yours - ultra sound guided with a spring loaded core retrieval gun. I didn't get any local anesthesia for those and the samples were taken just below my sternum and not through my ribcage like the bedside biopsies. I didn't feel a thing. Having had the more traditional and the spring loaded I definitely prefer the latter. My last one was in my birthday and it made for a very special day. I loved it!
Mike
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Thanks for sharing your recent experience with a biopsy! It helps to know what to expect.  Wishing you the best results in your treatment! Sincerely, 5Annie7
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Dear Hector, Thanks again for your insight and advice! You appear to be a guardian angel on this site with helping others. Hope I can share some helpful info with you sometime, if needed. Here's hoping for recovery for you!!! Sincerely, 5Annie7
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I sure appreciate your detailed description of your biopsy. It helps to know what to expect. Hope your results are good and your treatment is quick and effective! Sincerely, 5Annie7
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Thanks for telling about your biopsies! Sure hope the days ahead will be better with your transplant! Sincerely, 5Annie7
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Avatar_n_tn
mike: congratulations on getting it over with; as "gold standards" go, it definitely has its shortcoming, but there isn't yet anything more definitive. And I wouldn't worry too much about the gaping hole left behind . From that article I linked in the earlier post,

"Considering that a biopsy sample taken from an adult corresponds to a fraction of just 1/50,000th to 1/100,000th of the whole liver, a biopsy specimen would seem to be inadequate in the case of nonfocal diseases, such as a chronic viral hepatitis, in which the liver changes may be unevenly distributed" (they then go on to argue that as a random sample it *is* good enough).

but you'll never miss 1/50,0000 .

hector : thanks for the article. I'm going in for a laparoscopic bx Friday.  This is my 4th and definitely the most invasive - post observation is a  full day - but hopefully they'll finally make some sense of what stage it's actually at, and I might even get a video out of it. But the comment "very few gastroenterology training programs now provide instruction in the procedure" wasn't entirely reassuring.
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