Percutaneous Liver Biopsy

Percutaneous Liver Biopsy

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Percutaneous liver biopsy is a procedure in which a long needle is introduced through the skin, subcutaneous tissues, intercostal muscles, and peritoneum into the liver to obtain a specimen of liver tissue. [1, 2] This procedure is usually performed on an outpatient basis. The patient is then observed for a few hours in the hospital or the ambulatory unit. It is safe in pediatric [3, 4] as well as adult patients, with a low complication rate.

The liver biopsy needle used can be one of the following three types:

This topic focuses on the technical aspects of performing a percutaneous liver biopsy. For a more detailed discussion of the theoretical aspects, see Diagnostic Liver Biopsy.

Indications related to initial diagnosis include the following:

Indications related to surveiilance during treatment include the following:

Indications relevant to the patient who has undergone a liver transplant include the following:

Contraindications include the following:

Generally, performance of percutaneous liver biopsy should adhere to the following guidelines, which are modified from the American Gastroenterological Association’s 1989 position statement [9] :

Karamshi M. Performing a percutaneous liver biopsy in parenchymal liver diseases. Br J Nurs. 2008 Jun 26-Jul 9. 17(12):746-52. [Medline].

Myers RP, Fong A, Shaheen AA. Utilization rates, complications and costs of percutaneous liver biopsy: a population-based study including 4275 biopsies. Liver Int. 2008 May. 28(5):705-12. [Medline].

Almeida P, Schreiber RA, Liang J, Mujawar Q, Guttman OR. Clinical Characteristics and Complications of Pediatric Liver Biopsy: A Single Centre Experience. Ann Hepatol. 2017 Sep-Oct. 16 (5):797-801. [Medline].

Bolia R, Matta J, Malik R, Hardikar W. Outpatient Liver Biopsy in Children: Safety, Feasibility, and Economic Impact. J Pediatr Gastroenterol Nutr. 2017 Jul. 65 (1):86-88. [Medline].

Gilmore IT, Burroughs A, Murray-Lyon IM, Williams R, Jenkins D, Hopkins A. Indications, methods, and outcomes of percutaneous liver biopsy in England and Wales: an audit by the British Society of Gastroenterology and the Royal College of Physicians of London. Gut. 1995 Mar. 36(3):437-41. [Medline].

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Grant A, Neuberger J. Guidelines on the use of liver biopsy in clinical practice. British Society of Gastroenterology. Gut. 1999 Oct. 45 Suppl 4:IV1-IV11. [Medline].

Jacobs WH, Goldberg SB. Statement on outpatient percutaneous liver biopsy. Dig Dis Sci. 1989 Mar. 34(3):322-3. [Medline].

Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD, American Association for the Study of Liver Diseases. Liver biopsy. Hepatology. 2009 Mar. 49 (3):1017-44. [Medline].

Caturelli E, Giacobbe A, Facciorusso D, Bisceglia M, Villani MR, Siena DA, et al. Percutaneous biopsy in diffuse liver disease: increasing diagnostic yield and decreasing complication rate by routine ultrasound assessment of puncture site. Am J Gastroenterol. 1996 Jul. 91(7):1318-21. [Medline].

Hakime A, Barah A, Deschamps F, Farouil G, Joskin J, Tselikas L, et al. Prospective Comparison of Freehand and Electromagnetic Needle Tracking for US-guided Percutaneous Liver Biopsy. J Vasc Interv Radiol. 2013 Nov. 24(11):1682-9. [Medline].

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Filingeri V, Sforza D, Tisone G. Complications and risk factors of a large series of percutaneous liver biopsies in patients with liver transplantation or liver disease. Eur Rev Med Pharmacol Sci. 2015 May. 19 (9):1621-9. [Medline].

McGill DB, Rakela J, Zinsmeister AR, Ott BJ. A 21-year experience with major hemorrhage after percutaneous liver biopsy. Gastroenterology. 1990 Nov. 99(5):1396-400. [Medline].

Froehlich F, Lamy O, Fried M, Gonvers JJ. Practice and complications of liver biopsy. Results of a nationwide survey in Switzerland. Dig Dis Sci. 1993 Aug. 38(8):1480-4. [Medline].

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Boschuetz N, Gray M, Bari K. Portal Vein Thrombosis After Percutaneous Liver Biopsy. Clin Gastroenterol Hepatol. 2017 Aug 2. [Medline]. [Full Text].

Gaurav Arora, MD, MS Assistant Professor of Internal Medicine, Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Southwestern Medical School

Gaurav Arora, MD, MS is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, American Association of Physicians of Indian Origin

Disclosure: Nothing to disclose.

Walid S Ayoub, MD Clinical Assistant Professor of Medicine, Division of Gastroenterology and Hepatology and Liver Transplant Program, Stanford University School of Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Luis M Lovato, MD Associate Clinical Professor, University of California, Los Angeles, David Geffen School of Medicine; Director of Critical Care, Department of Emergency Medicine, Olive View-UCLA Medical Center

Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Kurt E Roberts, MD Assistant Professor, Section of Surgical Gastroenterology, Department of Surgery, Director, Surgical Endoscopy, Associate Director, Surgical Skills and Simulation Center and Surgical Clerkship, Yale University School of Medicine

Kurt E Roberts, MD is a member of the following medical societies: American College of Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons

Disclosure: Nothing to disclose.

Joseph K Lim, MD Associate Professor of Medicine, Director, Yale Viral Hepatitis Program, Section of Digestive Diseases, Yale University School of Medicine

Joseph K Lim, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.


The authors gratefully acknowledge the unnamed patient who graciously agreed to be photographed during the procedure for this article.

The authors and editors of also gratefully acknowledge the assistance of Lars Grimm with the literature review and referencing for this article.

Medscape Drugs & Diseases thanks George Y Wu, MD, PhD, Professor, Department of Medicine, Director, Hepatology Section, Herman Lopata Chair in Hepatitis Research, University of Connecticut School of Medicine, for assistance with the video contribution to this article.

Percutaneous Liver Biopsy

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