Trans-Jugular Liver Biopsy (TJLB)

What is a trans-jugular liver biopsy (TJLB)?

Trans-jugular liver biopsy or TJLB is taking a sample of tissue from the liver. It is conducted to diagnose, grade and stage progression of liver disease. The sample is taken by passing a needle directly from the vein in the neck (jugular vein) to the inside of the liver. The sample will be looked at under a microscope by a pathologist and will help your liver doctor to diagnose and treat your condition.

How is a trans-jugular liver biopsy performed?

Consent

Before the procedure, the Radiologist will meet you in our recovery area to discuss the procedure in more detail, the risks and answer any of your questions to your satisfaction before you provide your permission and sign your consent form.

Anaesthetic

This procedure is usually performed using local anaesthesia, which means you will be awake. The skin over the side of the neck is cleaned with an antiseptic and local anaesthetic is injected to numb the skin and the deeper tissues. The needle and tube being passed into the liver may be slightly uncomfortable but this will only last a few seconds.

Procedure

TJLB usually takes about 30 minutes to an hour, though every patient is different and some procedures may take longer. In a trans-jugular liver biopsy, a thin tube is inserted through a large vein in your neck and passed down into your liver (hepatic) vein. This procedure involves taking a tiny specimen of the liver for examination under a microscope. TJLB is an alternative way of obtaining the liver specimen by passing the needle through the vein in the neck as opposed to a percutaneous liver biopsy (biopsy taken through the side of the abdomen directly). This method is usually used in patients who have abnormal clotting of the blood or fluid collecting within the abdomen. This technique usually results in a reduced risk of bleeding after the biopsy.

Staff involved

Interventional Radiology (IR) procedures are performed by a multidisciplinary team. The team includes the following key Staff:

Interventional Radiologist (Consultant/Fellow):
A doctor specially trained in minimally invasive, image-guided techniques who performs the procedure.

Radiology Nurses:
Highly trained nurses who care for the patient before, during, and after the procedure. They assist with sedation, monitor vital signs (heart rate, breathing, oxygen levels), and may “scrub in” to assist the radiologist directly.

Radiographers:
Experts in imaging equipment who operate the machines to provide real-time guidance for the doctor.

Senior Clinical Support Workers (SCSWs):
Assist with the setup of the room, patient positioning, and maintenance of sterile conditions.

What are the risks

TJLB is a generally safe procedure, and like all procedures, there is a risk of some complications, such as:

• Pain at the biopsy site is the most common complication after a liver biopsy.
• Bleeding can occur after a liver biopsy; however, a trans-jugular liver biopsy has a lower risk than a percutaneous liver biopsy.
• Contrast dye (mild symptoms like nausea, itchiness and rashes occur in 1%; moderate to severe symptoms such as severe vomiting, difficulty breathing occur in 1 in 3,000; risk of death is rare, estimated at 1:170,000).
• Radiation exposure during interventional procedures is generally regarded as low but higher radiation doses might be necessary in difficult or complex cases.
• In rare instances, the needle may inadvertently puncture another internal organ, such as the gallbladder.

What to expect from this procedure?

Admission

You will be admitted the night before your procedure under the care of the liver team or you may already be on a ward. Your doctor will arrange:

• Specific and up-to-date blood tests – these are required to make sure it’s safe to carry out the procedure.
• A cannula will be inserted in your arm, and you may need a fluid drip overnight or antibiotics before your procedure.

Pre-operative preparation

To promote patient safety during your procedure, the following patient preparation are required:

• You do not need to fast for this procedure unless you were instructed by someone from our team.
• To lessen your risk of getting an infection, you may be prescribed a course of antiseptic wash and nasal cream.
• Most blood thinning medications need to be omitted, please discuss with us if you are taking any.
• If you have bleeding disorders or your blood clotting function is above threshold, you may require blood transfusion or other medications; please inform us if you have concerns about this.

Recovery

After the procedure, you will be transferred to our recovery area, where you will be closely monitored:

• Your vital signs and the punctured site will be monitored regularly.
• You will be placed on bed rest for several hours to allow you to recover from the procedure and reduce your bleeding risk.

Aftercare

Once stable, you will then be transferred back to the liver ward to recuperate. You may expect the following:

• Stiffness in your neck, discomfort in your abdomen or pain in your right shoulder are related to the procedure. These will normally improve with pain medications.
• Your blood tests may also be checked to allow your liver doctor to ascertain when it’s safe for you to be discharged from the hospital.

Care at home

The recovery after TJLB is usually straightforward. Patients can often go back to their usual activities after a week.

• Exercise: limit your activities, get plenty of rest and gradually introduce light exercise after a week.
• Work: we advise a period of about 5-7 days to rest after a TJLB; a sick note may be requested from your liver doctor if needed.
• Driving/travel: there is no definite contra-indication for traveling; however, you are advised not to drive for at least 72 hours after your procedure.
• Medicines: your medications will be sorted by a ward doctor before you’re discharged; it is best to keep your usual pain medications at home, when required.
• Follow-up: your liver doctor will explain the results when the biopsy report comes back from histopathology, this may be anywhere between 2 days to 2 weeks.
• Please seek immediate medical attention if you experience severe symptoms such as uncontrollable pain and breathing difficulties.

Contact information

We hope some of your questions have been answered by this leaflet. If there are any questions you would like to ask before you come for your procedure, please get in touch.

How to get to our department

We are located in the Ground Floor of Lincoln Wing at
St James’s University Hospital.