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EUS Guided Liver Biopsy

Endoscopic Ultrasound Guided Liver Biopsy

A liver biopsy is a technique that is used for diagnosing abnormal liver conditions. It is an outpatient procedure that involves obtaining a piece of liver tissue for analysis. The obtained liver tissue allows your doctor to see if the liver is healthy or to better understand the extent of liver damage.

The liver is located on the upper right of the abdominal area, and multiple conditions can lead to liver damage.

Reasons for a Liver Biopsy

A liver biopsy may be recommended in the following instances:

  • Symptoms, scans (MRI, CT, Ultrasound), and blood tests suggest presence of liver disease
  • Assessing the extent of fibrosis or scarring in the liver due to certain diseases such as Wilson’s disease, chronic hepatitis B or C, autoimmune hepatitis, and primary biliary cirrhosis.
  • Presence of a lump in the liver
  • Monitoring a liver after a liver transplantation
  • Assessing the degree of liver damage or inflammation
  • Assessing the progression or stage of a known liver condition
  • To diagnose cancer

Traditionally, liver biopsy has been performed in the x-ray department with the ‘across the skin’ or percutaneous approach. This technique would require the patient to be awake and a local anesthetic together with anti-anxiety medications administered to ensure that they are comfortable. After the procedure, the patient would lie on their right side for several hours and are advised to not do any activities for a few days following the procedure.

Endoscopic Ultrasound (EUS) Guided Liver Biopsy

With the advancement in technology of better equipment and needles, Endoscopic Ultrasound can now be used to obtain a liver biopsy. Endoscopic Ultrasound (EUS) is used to obtain tissue samples from lesions in the GI tract but it can also be used to sample masses from the liver as well.

Advantages of EUS guided liver biopsy include:

  • Simultaneously examines the upper GI tract with an upper endoscopy while also evaluating the gallbladder, pancreas, and bile ducts
  • The patient is asleep during the procedure hence improved patient experience

The Procedure

Before the procedure, your doctor will provide you with pre-operative instructions which you need to follow in order to reduce the risks of the surgery and provide an optimal outcome.

The instructions include to stop or adjust certain medications and not to eat anything from midnight on the day of the surgery. You should also let your doctor know any allergies you may have and the kind of medication you are taking.

EUS-guided liver biopsy is an outpatient procedure that takes an average of 20-30 minutes to complete. Anesthesia is administered and a needle is guided across the wall of the stomach into the liver to obtain tissue for analysis by a pathologist under a microscope.

After the Procedure

Following the procedure, you will be monitored for a few hours and your doctor will discuss with you the possible findings of the biopsy, but it may take several days for the final results of the biopsy to be available.

Due to the effects of the anesthesia, it important not to make big decisions or operate machinery for the next 24 hours. You can eat once you leave the hospital unless instructed otherwise.

EUS guided liver biopsy is considered a generally safe procedure with minimal but rare risks such as bleeding and infection.


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