Liver Biopsy

Written by Kristen Fischer
Medically Reviewed by Melinda Ratini, MS, DO on November 22, 2024
8 min read

If your doctor recommends a liver biopsy, you may feel anxious. A biopsy involves collecting tissue from inside your body so a doctor can study it. The procedure may be uncomfortable, but it’s usually described as being more of a pressure than a pain.

A liver biopsy is a procedure in which a small needle is inserted into your liver to collect a tissue sample. A pathologist, a doctor who specializes in looking at different types of tissue, looks at the sample to diagnose a variety of disorders and diseases in your liver. In many cases, you aren’t put to sleep. But sedation (relaxation or sleepiness caused by drugs that a doctor gives you) can help you relax during the fairly quick procedure. 

A liver biopsy is most often performed to help identify the cause of:

  • Constant abnormal liver blood tests (liver enzymes)
  • Unexplained yellowing of the skin (jaundice)
  • An issue in your liver found on an ultrasound, computed tomography (CT) scan, or nuclear scan
  • Unexplained liver growth

Reasons for a liver biopsy

A liver biopsy is used to diagnose liver diseases and lesions in the liver. It can diagnose liver diseases such as:

  • Liver cancer
  • Fatty liver disease
  • Hepatitis
  • Cirrhosis of the liver

The procedure can also diagnose types of liver tumors and cysts, and monitor liver health after a transplant. Doctors use it to pinpoint causes or types of liver disease. Also, a liver biopsy can monitor your liver disease if you already have one. It can tell how much scarring is in your liver and help doctors grade and stage hepatitis B and C. It can also help doctors see if treatment for an existing problem is working.

Overall, the procedure can diagnose problems and give your doctor concrete details to guide treatment.

How painful is a liver biopsy? 

The idea of having a needle put into your body may sound painful, but you won’t feel pain when the biopsy needle goes into your liver. 

The doctor will inject a local anesthetic into your skin. The medicine may sting for a minute before it starts working. The anesthetic will numb the area so you don’t feel the biopsy needle. During the biopsy needle injection, you may feel pressure or discomfort, but not pain.

There are a few types of liver biopsy. Your doctor can tell you which type is best for you.

Percutaneous liver biopsy

This is the most common type of liver biopsy. It’s the least invasive method. Your doctor will place a needle into your abdomen (belly area) and into your liver to get a sample of liver tissue.

Plugged liver biopsy

This is similar to the percutaneous liver biopsy but involves plugging the needle tract with a gel or coils after the tissue sample is taken. Your doctor may recommend this if you have a high risk of bleeding.

Laparoscopic liver biopsy

Your doctor will make a cut in your abdomen and insert a laparoscope, which is a thin tube with a camera attached. The device will send images of your liver to a monitor so the doctor can see inside your body. Then the doctor will use small tools to remove tissue from your liver. This type of biopsy may be used when tissue samples are needed from specific parts of your liver. You’ll typically have general anesthesia and will be asleep for this type of procedure.

Transvenous liver biopsy

This type of biopsy is used if you have blood clotting problems or fluid in your abdomen. The doctor inserts a tube called a catheter into a vein in your neck and guides it to your liver. The doctor will use fluoroscopy, an X-ray imaging technique, to see where your vein and liver connect. A biopsy needle is placed into the catheter and then into your liver to get a sample.

Transjugular liver biopsy

Similar to a transvenous liver biopsy, this type of biopsy involves placing the biopsy needle through a tiny catheter in your jugular vein (a blood vessel that stretches from your head to your upper chest) and reaching your liver to gather a sample of tissue.

When preparing for a liver biopsy, you should:

  • Tell your doctor if you're pregnant, have a lung or heart condition, are allergic to any medications, or have bleeding problems.
  • Tell your doctor about all the medications and supplements that you’re taking. Make sure to tell them if you’re taking blood-thinning medications such as apixaban (Eliquis), aspirin, clopidogrel (Plavix), or warfarin (Coumadin). Your doctor may prescribe a different way to thin your blood before the procedure.
  • Talk with your doctor about the procedure and ask any questions you may have.
  • Have any necessary blood or imaging tests done.
  • Find out how long before the procedure you'll need to stop eating.
  • Arrange for a ride home after the procedure.

For the week before the procedure, don’t take aspirin, products containing aspirin, or anti-inflammatory drugs (such as ibuprofen, indomethacin (Indocin), or naproxen (Naprosyn)) unless otherwise advised by your doctor. Don’t stop taking any medication without first talking to your doctor.

Now that you know the different types of liver biopsies, it’s good to understand exactly what happens during the procedure. 

Laboratory tests will be done on the day of a liver biopsy or two to three days before it, as directed by your doctor. These tests may include a blood count, a platelet count, and a measurement of your blood's ability to clot.

Before the procedure:

  • A doctor will explain the biopsy procedure in detail, including possible complications, and answer any questions you may have.
  • Your doctor may give you the option of being sedated during the procedure. 
  • You may need to have imaging tests done, such as ultrasound or CT scan. The tests can help the doctor see where it's best to insert the needle. 

During the procedure (which typically takes anywhere from 15 to 60 minutes):

  • You’ll be asked to wear a hospital gown.
  • You’ll lie on your back, with your right elbow out to the side and your right hand under your head. It’s important that you remain as still as possible during the procedure.
  • An ultrasound may be used to mark the location of your liver.
  • You may receive a small dose of a sedative just before the procedure.
  • The doctor will clean and numb an area on your upper abdomen with a local anesthetic (pain-relieving medication). The doctor will then make a small cut on your upper abdomen and insert a needle into this area to take a small sample of liver tissue to study.

After the procedure:

  • You will stay in a recovery room for two to four hours so that doctors can check on you.
  • You may feel minor pain or soreness at the biopsy site and discomfort or a dull pain in your shoulders or back. If necessary, a pain medication will be prescribed for you.
  • Don’t drive or use machinery for at least eight hours after the procedure.
  • Avoid taking aspirin, products containing aspirin, or anti-inflammatory drugs for a week after the procedure. You can take acetaminophen if needed.
  • Don’t do intense physical activity or heavy lifting for about a week after the biopsy.
  • Your doctor will discuss the biopsy results with you several days after the procedure.

Liver biopsy position

Unless the doctor says otherwise, they’ll ask you to lie on your back with your right hand under your head and your elbow out to your side. 

How long does a liver biopsy take?

This will depend on the type of liver biopsy your doctor uses. A percutaneous biopsy can last anywhere from 15 to 30 minutes, while a transvenous biopsy can take about 30 to 60 minutes. 

Liver biopsy recovery

Your care team will make sure that you’ve recovered without issues. You’ll stay in a recovery room for about two to four hours to make sure everything is all right. If you have any pain, your doctor will treat it.

Avoid rigorous exercise or heavy lifting for about a week after the procedure. Keep the area around your cut clean to avoid infections. 

In most cases, there are no complications from having a liver biopsy. But, rarely, bleeding may happen inside your body, as well as a leak of bile (digestive fluid) from your liver or gallbladder. There’s a slight risk of a pneumothorax, also called a collapsed lung, if the biopsy needle makes a hole in your chest wall, causing air to enter.

If these symptoms happen within 72 hours of your biopsy, call your doctor or go to the nearest emergency room:

Call 911 if you have any chest pain or trouble breathing.

Signs of internal bleeding after a liver biopsy

Internal bleeding can cause severe or long-lasting pain, a fast heart rate, and low blood pressure. Your care team will monitor you for these signs.

If internal bleeding happens, your doctor may recommend a blood transfusion or another procedure to stop the bleeding. About 1 in every 500 people who have had liver biopsies have some bleeding.

After the procedure, your tissue sample will go to a lab for analysis. Your doctor will tell you how long it’ll take until they can give you the results.

A liver biopsy involves analyzing a sample of tissue from your liver. The results are used to diagnose a liver-related problem or monitor an existing condition. 

There are different kinds of methods used to collect a sample. A biopsy involves inserting a needle into your liver. The area is numbed, and you might be sedated to lessen any discomfort or anxiety.

Can the doctor put me to sleep during the liver biopsy?

It’s not commonly done. But the doctor can give you sedation to help you relax.

How long does a liver biopsy take?

The time is based on the type of liver biopsy your doctor uses. The actual procedure of the needle going in typically takes about five minutes. From start to finish, a percutaneous biopsy can last anywhere from 15 to 30 minutes, while a transvenous biopsy can take 30 to 60 minutes.

Who isn’t a candidate for a percutaneous liver biopsy?
A percutaneous biopsy is the most common type of liver biopsy, but your doctor may recommend using a different technique if you have a hard time staying still, obesity, a possible tumor in your liver, a lot of fluid in your abdomen, a history of bleeding, or a liver infection.

Do I have to stay in a hospital?

Most liver biopsies are done in outpatient facilities, meaning that you’ll go home later in the day.