Trans-jugular liver biopsy

What is a trans-jugular liver biopsy?

A trans-jugular liver biopsy involves getting a sample of your liver for further investigations. This sample is obtained by entering the vein in your neck and then using x-rays to guide the biopsy needle into your liver. The sample is looked at under a microscope and is used to diagnose abnormalities and monitor certain conditions of the liver.

The trans-jugular approach has been chosen by your doctor as the safest way for you—most probably because your blood is not clotting correctly. With this technique, any bleeding caused by the procedure will be into your veins and so no blood will be lost.

Risks and benefits

The benefit of this procedure is that it will help us to investigate the cause of your symptoms and decide what the best treatment is for you.

It is common to get a small bruise on your neck at the needle entry site. There is a very small risk that bleeding might occur from the site of needle entry into the liver. Very rarely other organs such as the kidneys, lungs, or bowel might be punctured. Puncture of the gallbladder may cause bile to leak out into your abdomen causing an infection called peritonitis. We will discuss the risks and benefits with you in detail before the procedure.

Before you come in

Please let your doctor know if you take medication to thin the blood or have any allergies. A few days before your trans-jugular liver biopsy you will need to have a blood test.

You will be spending approximately four hours resting in bed—therefore we recommend that you bring a book, magazine or personal music system with you into hospital.

If your procedure is being done on an outpatient basis, please arrange to have an escort home and a friend or family member (must be a responsible adult) to stay with you until the following day. This is very important otherwise you will not be able to have your trans-jugular liver biopsy.

On the day of your procedure

Do not eat or drink for 6 hours before your appointment. Please take all your medications as usual (except aspirin or warfarin).

During the procedure

Prior to the procedure you will be seen by a doctor. This is an opportunity to discuss the procedure before signing a consent form. Please ask any questions you may have as it is important that you understand what is going to happen.

In the procedure room you will lie on an X-ray bed. Your neck will be cleaned with antiseptic fluid and you will be covered with a sterile drape. The doctor will give you an injection of local anaesthetic to numb the skin in your neck just by your collarbone. This will cause some stinging initially and then go numb. Throughout the procedure a nurse will be with you who will monitor your pulse and blood pressure.

Please let the nurse know if you feel any discomfort. The procedure should not cause you any pain.

The doctor will insert a catheter (fine plastic tube) into the vein in your neck. They will inject dye to highlight your veins and then take x-ray pictures to help guide the catheter into the vein in your liver.

A biopsy needle is then inserted through this tube and into the liver to obtain samples of tissue. We will explain what is happening throughout the procedure.  

The procedure usually takes 30–60 minutes but may take longer.

After the procedure

You will go back to the ward where your nurse will record your pulse and blood pressure as well as check the needle site regularly. You may feel some discomfort around the biopsy site and pain in your right shoulder which can be treated with pain relieving tablets.

You will be required to rest in bed for four hours. If you feel unwell at any time, please tell your nurse.

Going home

Once your nurse is happy that you have recovered completely from your biopsy, you will be discharged from hospital and your friend/family member can take you home.

After you are home

• Please rest quietly at home for the remainder of the day and the following day.
• The waterproof dressing may remain on your neck for 3–4 days. Avoid baths over this time until the skin site is healed. You may only shower.
• If your job doesn’t involve any manual work or lifting, you can return to work two days after the biopsy.

Please contact your GP if you experience any pain on breathing, severe pain in your stomach, or a high temperature.

Contact information

Chelsea and Westminster Hospital

Interventional Radiology Department
1st Floor, Lift Bank D

T: 020 3315 8570/8582