This information will help you prepare for your percutaneous liver biopsy in the endoscopy unit at Memorial Sloan Kettering Cancer Center (MSK). During your liver biopsy, your doctor will use a needle to remove a sample of tissue from your liver.
Your liver has many important functions, including:
- Producing and secreting bile to digest fat
- Helping the body use and store proteins and carbohydrates for energy
- Helping with blood clotting
- Helping with the storage of some vitamins
- Helping the body get rid of drugs, dyes, and other toxic substances
Your doctor will talk with you about why you are having a liver biopsy. Liver biopsies are done for many reasons, such as to look for causes of abnormal blood tests, to evaluate abnormalities in the liver that may have been seen during other radiology tests, or to check a person's response to treatment. Liver biopsies may also be done to find the cause of:
- Abnormal liver enzymes
- An enlarged liver
- Tea-colored urine
- Weight loss
- Yellowish color of the skin and the whites of the eyes (jaundice)
2 Weeks Before Your Procedure
Ask about your medications
You may need to stop taking some of your medications before your procedure. We have included some common examples below. Do not stop taking any of your medications without talking with your doctor first.
- If you take medication to thin your blood, such as to treat blood clots or to prevent a heart attack or stroke, ask the doctor who prescribes it for you when to stop taking it and contact the doctor performing your liver biopsy. Some examples are warfarin (Coumadin®), dalteparin (Fragmin®), heparin, tinzaparin (Innohep®), enoxaparin (Lovenox®), aspirin, dipyridamole (Persantine®), clopidogrel (Plavix®), and cilostazol (Pletal®).
- If you take insulin or other medication for diabetes, you may need to change the dose. Ask the doctor who prescribes your diabetes medication what you should do the morning of your procedure.
- Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil®, Motrin®) or naproxen (Aleve®) 7 days before your liver biopsy. If you're having pain or discomfort, take acetaminophen (Tylenol®) instead. Do not take more acetaminophen than directed on the label or by your doctor.
- Stop taking any herbal remedies and supplements, such as fish oil, vitamin E, and ginkgo biloba, 7 days before your procedure.
Get a letter from your doctor, if necessary
If you have an automatic implantable cardioverter-defibrillator (AICD), you will need to get a clearance letter from your cardiologist before your procedure.
Arrange for someone to take you home
You must have someone 18 years or older take you home after your procedure. Please call one of the agencies below if you do not have someone who can do this. They will help find someone you can hire to take you home.
Partners in Care: (888) 735-8913
Caring People: (877) 227-4649
3 Days Before Your Procedure
You will receive a telephone call from an endoscopy nurse. He or she will review the instructions in this guide with you and ask you questions about your medical history. The nurse will also review your medications and tell you which to take the morning of your procedure. Use the space below to write them down.
Get the time of your procedure
A clerk from the Admitting Office will call you after 2:00 pm the day before your procedure. He or she will tell you what time you should arrive at the hospital for your procedure. If you are scheduled for your procedure on a Monday, you will be called on the Friday before. If you do not receive a call by 7:00 pm, please call (212) 639-7882. If you need to cancel your procedure for any reason please call the doctor who scheduled it for you.
The Day of Your Procedure
Do not eat or drink anything after midnight the night before your procedure. This includes water, hard candy, and gum.
- Take only the medications your doctor told you to take the morning of your procedure. You may have written them down in this guide.
Things to remember
- Do not put on any lotion, cream, powder, make-up, or perfume.
- Remove any jewelry, including body piercings.
- Leave all valuables such as credit cards and jewelry at home.
- If you wear contact lenses, wear your glasses instead.
What to bring with you
- A list of the medications you take at home
- Medications for breathing problems (such as inhalers), medications for chest pain, or both
- A case for your glasses
- Your Health Care Proxy form if you have completed one
Where to Park
Parking at MSKCC is available in the garage on East 66th Street between York and First Avenues. To reach the garage, enter East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a pedestrian tunnel that goes from the garage into the hospital. There are also commercial garages nearby: 4 on East 69th Street between First and Second Avenues and 3 on East 65th Street between First and Second Avenues. For questions about prices, call (212) 639-2338.
Where to go
Please arrive at the Surgical Day Hospital (SDH) at 1275 York Avenue. This is the main building of MSKCC. Take the M elevator to the 2nd floor.
What to expect
Once you arrive at the hospital, doctors, nurses, and other staff members will ask you to state and spell your name and date of birth many times. This is for your safety. Patients with the same or similar names may be having procedures on the same day.
After changing into a hospital gown, you will meet your nurse. He or she will place an intravenous (IV) catheter into a vein, usually in your hand or arm. At first you will receive fluids through the IV, but it will be used later to give you anesthesia (medication to make you sleepy). Your doctor will explain the procedure, and answer any questions you have.
When it's time for your procedure, you will be brought into the procedure room and helped onto an exam table. You will be attached to equipment to monitor your heart, breathing, and blood pressure. You will also receive oxygen through your nose. You will lie on your back, with your right arm raised with your right hand resting next to your head.
You will receive medication through your IV, which will make you relax. Once you're comfortable, your doctor will use a medication to numb the area. Some people say they feel pressure when the needle is inserted, but you should not feel any pain. You will have a small bandage on the biopsy site when it's finished.
After Your Procedure
In the recovery room
You will wake up in the recovery room, where you will remain in bed for 4 to 6 hours. Your nurse will continue to monitor your heart, breathing, and blood pressure. Please tell him or her if you have any discomfort, shortness of breath, or dizziness. When you're ready to leave the hospital, your nurse will remove your IV. If you have someone waiting with you your nurse will explain your discharge instructions to both of you before you go home.
- Do not drink alcoholic beverages for 24 hours after your procedure.
- In addition to resting the day of the biopsy, you should plan to take it easy for the next week. For at least 3 days, do not:
- Do any strenuous activities
- Lift anything more than 10 pounds
- Vacuum, garden, or play sports
- For 1 week, do not lift more than 15 pounds
- Since this is a biopsy of an area that has a lot of blood vessels, do not take any medications that may thin your blood until your doctor tells you it is safe, including:
- Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
- Blood thinners
- Herbal remedies and supplements (such as gingko biloba and fish oil)
- Vitamin E
Call Your Doctor or Nurse If You Have:
- Chest pain or shortness of breath
- A temperature of 101° F (38.3° C) or higher
- Severe pain at the biopsy site, shoulder, stomach pain, swelling, or hardness
- Bleeding from the biopsy site
- Vomiting of blood
- Blood in your stool or black tarry stool
- Weakness, faintness, or sweating
- Heart palpitations
- Any of the following signs of infection or bleeding at the biopsy needle insertion site:
- Increased warmth
- Bluish discoloration