Transjugular liver biopsy
- Felipe B Collares, MD
Felipe B Collares, MD
- Instructor in Radiology
- Harvard Medical School
- Stephan Anderson, MD
Stephan Anderson, MD
- Associate Professor of Radiology
- Boston University School of Medicine
- Section Editors
- Sanjiv Chopra, MD, MACP
Sanjiv Chopra, MD, MACP
- Editor-in-Chief — Gastroenterology/Hepatology
- Section Editor — General Hepatology
- Section Editor — Gallbladder and Biliary Tract Disease
- Professor of Medicine
- Harvard Medical School
- Senior Consultant in Hepatology
- James Tullis Firm Chief
- Beth Israel Deaconess Medical Center
- Jonathan B Kruskal, MD, PhD
Jonathan B Kruskal, MD, PhD
- Section Editor — Kidney Disease
- Professor of Radiology
- Harvard Medical School
Despite the progress and advances in clinical medicine, biochemical analysis, and diagnostic imaging, histologic examination of hepatic tissue still has an important role in the management of patients with liver diseases. Percutaneous liver biopsy has proven to be fast, safe, and efficient, to the point of becoming the gold standard for liver tissue sampling.
However, percutaneous liver biopsy involves transection of the liver capsule, and patients taking anticoagulants or with coagulopathies are at an increased risk for intraperitoneal hemorrhage (table 1). Other factors such as morbid obesity and high-volume ascites also represent a challenge for the percutaneous approach, increasing the risks associated with the procedure. Consequently, alternative techniques such as transjugular liver biopsy were developed to permit harvesting of liver tissue in patients with contraindications to the percutaneous procedure [1,2]. (See "Percutaneous, fine-needle aspiration, and laparoscopic liver biopsy".)
This topic will review transjugular liver biopsy. Percutaneous liver biopsy, transjugular intrahepatic portosystemic shunting, and the interpretation of biopsy specimens are discussed separately. (See "Percutaneous, fine-needle aspiration, and laparoscopic liver biopsy" and "Transjugular intrahepatic portosystemic shunts: Indications and contraindications" and "Interpretation of liver biopsy specimens".)
INDICATIONS AND CONTRAINDICATIONS
Liver biopsy provides useful information that can be used for the diagnosis, prognosis, staging, and management of patients with acute or chronic liver diseases (table 2). Indications for biopsy include characterization of parenchymal liver diseases, evaluation of abnormal liver function studies, characterization of abnormalities seen on imaging studies, detection and staging of adverse effects of drug treatment, evaluation of liver status following transplantation, evaluation of acute liver failure, and evaluation of fever of unknown origin.
Unlike a percutaneous biopsy, the transjugular approach accesses the liver parenchyma through the superior vena cava and hepatic vein and obtains hepatic tissue without traversing the liver capsule. Possible bleeding from the biopsy site is directed into the access vein, minimizing the risk of intraperitoneal hemorrhage.
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