Liver Biopsies: What to Expect

In this article, HepatitisC.net advocate Daniel Winterbottom shares his experiences with liver biopsies for hepatitis C, and what you can expect.

What's it like to receive a liver biopsy?

My first liver biopsy took place in 2008 as a required component of my hepatitis C monitoring process after I received a positive diagnosis in 2007. I received 4 needle liver biopsies until 2017 when the disease was successfully treated. The first biopsy was certainly the most difficult and scary. I had been briefed about the risks from my gastroenterologist, a hep C specialist, with the most severe risks being internal bleeding that most significantly can result in death, though are rare occurring 1 in 10,000 cases. Other common effects include pain resulting from cutting inserting the needle into the liver, and rarely, due to botched procedures, penetration of and damage to other organs.

I received the biopsies is a hospital where they have many departments, labs, surgical pavilions, etc. The provider has several branches throughout the Seattle area, and this one is the biggest. It's part of Kaiser Permenente, who bought out the original provider 8ish years ago.

The process

The process is relatively easy and short in time duration but comes with a bit of trepidation. I went to one of the branches of my health care provider and was signed in, given a waiting room, and asked to undress and cloaked in a medical gown. I was given a pill to relax, a mild sedative I assume. Approximately 15 minutes later, depending on how busy the staff where, I was wheeled into the procedure room and the process was explained again, at least the first time, after that I clearly knew the process. An antiseptic and topical numbing agent was applied where the needle would be inserted. This was followed by a gel rubbed on to my side to facilitate the ultra sound that helps guide the needle to the liver. The needle was then inserted between the middle ribs allowing the best alignment with the liver and several snips of the liver were cut, and the needle extracted. The bits are put into tubes and sent to the lab.

On one occasion, the technician asked if I’d like to see my liver, or rather fragments of it. I did and they were small and rather nondescript. The actual insert and taking samples was less than 5 minutes. After the procedure, I was wheeled back to the room waiting room and left for 1.5 hours for observation. I was asked how much pain I had at a 1-10 scale and offered pain medication if needed. I was not allowed to drive home, instead I was picked up once released. All normal activities were resumed by the next day. I was cautioned if any pain or unusual activity occurred to call immediately, as this could be a result of bleeding. There is a bit of modest bleeding since the liver is violated, but typically any serious bleeding happens within 1 hours of the procedure, thus the reason for the 1.5 hour observation session. The recovery was minimal, less than a day.

Did frequent liver biopsies disrupt your life? What were the out-of-pocket costs?

I have a medical provider Group Heath that has since been bought out by Kaiser Permanente. Group Health provided all of my hep C diagnosis and treatment with modest co-pays and the deductible. I was referred to a hep C specialist from the gastroenterology department once I was diagnosed and my doctor scheduled all of the liver biopsies and reviewed and communicated the results to me. I met with her or talked by phone after every biopsy to go over the results. This was very helpful, as the results posted on the web site were, for me, a bit of a challenge to understand; Having her walk me through them was very clarifying and made asking questions relatively easy.

The biopsies, for the most part, did not disrupt my life, as I could set the exact dates to meet my schedule and as noted above, its was really a day of lost time, minimal discomfort and after the first two, relatively low stress. Although, when the pulled out the needle and it isn’t small, I for the most part closed my eyes and thought about hiking in the Cascade mountains, the Pogues (Irish Paddy/Punk band), or my family. Anything to escape a long, long needle!