Liver biopsy

Types of liver biopsy

Percutaneous (through the skin) biopsy

In a percutaneous biopsy the needle is put through your skin, over your liver. This is on the right side of your tummy, just under your ribs.

The medical team usually use an ultrasound scan to help guide them to the right place. Sometimes a CT scan might be used.

Trans-jugular (through your jugular vein) biopsy

In a trans-jugular biopsy a small tube called a catheter is put into a vein in your neck.

The doctor will use X-rays to help them guide this tube down to your liver. They can then remove the liver sample through the tube.

Endoscopic ultrasound (EUS) biopsy

A biopsy sample can be taken during an endoscopy. This is a procedure where a thin flexible tube is passed down your throat and into your digestive system.

For an endoscopic ultrasound biopsy the tube will have a miniature ultrasound probe. This will help doctors to guide a needle through the stomach and into the liver.

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Risks and benefits of a liver biopsy

Most people who have a liver biopsy will have no serious problems from it. But all procedures have some risks. These are a bit different for everyone. You should be able to talk to your medical team about what these are for you.

It can help to ask about the benefits, risks, alternatives, and what would happen if you do nothing.

This is a rough guide. Your medical team should be able to give you more information.

Benefits

• A biopsy is the safest way to get a close look at the cells in your liver.
• It can help doctors to give you a definite diagnosis or rule out conditions you do not have.
• It can help you and your medical team to decide on the best treatment options for you.

Risks

There is a small risk of:

• bleeding
• infection
• accidental injury to another part of your body

Doctors will try to reduce the risk of these things as much as possible.

Alternatives

Other tests, including scans and blood tests can help doctors to find out what is going on in your whole liver, or in parts of it.

These tests cannot look really closely at your liver cells. The only other way to do this would be a full operation. The risks of this are much higher than the risks of a biopsy. It would also take a lot longer to recover.

Doing Nothing

If you do not have a biopsy, it might not be possible to work out exactly what is going on with your liver.

If this happens it will be harder to work out the best treatment options for you.

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Before your liver biopsy

Clotting test

About a week before your biopsy you should have a blood test. The test will check if your blood is clotting normally. People with cirrhosis often have a blood clotting problem. You might hear this called thrombocytopenia.

If your blood does not clot normally, you are at more risk of bleeding after a biopsy. So you might need some extra treatment or medicine before your biopsy.

• Find out more about blood clotting tests
• Find out more about thrombocytopenia and how it is treated.

Your regular medicines

Tell your medical team about all the medicines you take. Including any over the counter or alternative medicines or supplements. In can help to make a list of your medicines before you go. Include the dose and how often you take them.

It is especially important to tell them about warfarin or any other medicines used to stop blood clots (anticoagulants).

If you take regular aspirin you might need to stop taking this for 5 days before your biopsy.

Always ask your medical team before you stop or change any of your medicines.

Pain relief options

Talk to your medical team about your pain relief options before you go for your biopsy.

If you are having a needle put into your skin you will have a local anaesthetic.

You might also have a sedative. This is a medicine that makes you feel calm and sleepy.

If you have a sedative you will not be able to do some things like driving for 24 hours.

If you are having an endoscopic biopsy you may have a spray to numb your throat.

• More about anaesthetics and sedation

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On the day of your liver biopsy

Eating and drinking

You will probably be told not to eat or drink anything except water for 6 hours before your biopsy.

You will be able to drink plain water until 2 hours before your biopsy.

If you have diabetes and not eating will be a problem for you, let your medical team know.

What to wear

You will need to wear a hospital gown for your biopsy. It is best to wear clothes you can change in and out of easily.

Hospital gowns can have gaps in them. You can take a light dressing gown or long cardigan with you to wear over the gown while you wait.  Make sure it has loose sleeves and is easy to get on and off.

You will need to take off all your jewellery and piercings. So it is best to leave these at home.

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Having a liver biopsy

Preparation

Before your biopsy you will have to change into a hospital gown.

A nurse will put a canula into your arm or the back of your hand. This is a small plastic tube that makes it easy to give you medicines.

During the biopsy

Having an endoscopic biopsy (a tube down your throat) is very like having any other type of endoscopy for liver problems. You can find out more about having an endoscopy here.

This information is for people having a percutaneous or trans-jugular biopsy. These use a needle put into your skin.

You will be taken to the room for the biopsy. There might be a lot of big equipment in this room. This is so that the doctors can use a scanner to help them.

• You will be asked to lie down on a bed. You may have to lie in a particular position.
• The medical team will clean your skin where the needle will go in. This will either be on the right side of your tummy or on your neck.
• You will have an injection of local anaesthetic where the needle will go in.
• Once you are numb, the doctor will put the needle, or a thin tube called a catheter in.
• They will use X-ray, ultrasound or CT scans to guide the needle or tube to your liver.
• They will take the sample and bring it out of your body.
• The sample will be sent to a lab to be looked at under a microscope.
• The medical team will clean the area where the needle went in and put a dressing on it. You should not need any stitches.

You may be uncomfortable during the biopsy, but most people do not feel pain. Some people have told us they get a sudden shooting pain in their shoulder. This does not last long. But always tell the nurse if you have pain during a biopsy. They should be able to help you and give you medicine if needed.

The biopsy itself usually only takes around 10 minutes. But you will need to be in hospital for at least a few hours afterwards to make sure you are recovering well.

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After your liver biopsy

Hospital recovery

After your biopsy you will be moved to a recovery area.

You will be asked to stay there lying on your side or on your back for 2 to 3 hours. You will have regular checks on your temperature, blood pressure and pulse.

If you are going to stay in hospital you will be taken back to your ward.

If you are going home, you will probably stay in the recovery area for a total of 4 to 5 hours. This is to make sure you are recovering well and do not have any complications.

You will be able to have some food and drink in recovery. It can sometimes be a bit unpredictable when this will happen in a hospital. So you might want to bring something with you. For example a sandwich or some fruit. Particularly if you have special dietary needs.

Ask a nurse when you can eat and drink and when you can start to move about.

Going home

Someone else should drive you home or go home with you in a taxi. You should also have someone stay with you overnight.

Once you are home:

• rest for the rest of the day and the next day if you feel you need it
• do not go back to work or school on the day of your biopsy
• you can eat and drink and take your medicines as normal
• take painkillers if you need them
• you will need to wait for 24 hours after your biopsy before you have a shower or 48 hours for a bath

Checking the biopsy site (percutaneous biopsy)

If you had a biopsy where a needle was put through the skin on your stomach, look at the place where the needle went in (the biopsy site) regularly. It is normal to have a bit of bruising there.

In rare cases it can start to bleed or swell. If this happens:

• lie down
• put pressure on it for 10 minutes

If the bleeding or swelling has not stopped after 10 minutes, call 999 or go to A&E. Tell them you have had a biopsy.

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Getting your liver biopsy results

It usually takes about two weeks for the lab to look at your sample and send the results to your medical team. The result will go to the doctor who referred you for the biopsy.

If you are having other tests as well, your medical team will usually wait until they have all the results so that they can look at them all together.

If you do not have a follow up appointment booked, contact your liver medical team to find out how and when you will get your results.

Your results might give your medical team enough information to make a diagnosis. Or you might need to have more tests.

Liver conditions A to Z

Tests for liver disease

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Support for you

The British Liver Trust offers a range of support for people with a liver condition and those closest to them. This includes support groups and an online forum. Support for you.

You can also call or email our helpline. Our friendly team of specialist liver nurses cannot give you a diagnosis or interpret test results. But they can answer questions, offer support, or just listen.

Call the helpline on 0800 652 7330 or find out more here.

We also have lots of information about living with a liver condition:

• Liver blood tests (LFT)
• Tests for liver conditions
• Take our free online screener
• Liver conditions A to Z
• Useful words glossary
• Living with a liver condition
• Eating, drinking and keeping active
• Mental health

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Special thanks

We would like to thank the patients and doctors who helped up to create this information. Including Professor Stephen Ryder, consultant hepatologist at Nottingham University Hospitals NHS trust.

Published: August 2025

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