This information will help you prepare for your percutaneous (pur-kyoo-tay-nee-uhs) liver biopsy in the endoscopy unit at Memorial Sloan Kettering (MSK).
During your percutaneous liver biopsy, your doctor will insert a needle through your skin to remove a sample of tissue from your liver.
Your doctor will talk with you about why you’re having a liver biopsy. Liver biopsies are done for many reasons, including:
- To look for causes of abnormal blood tests
- To learn more about a liver abnormality that may have been seen during another test
- To check how you’re responding to treatment
- To find the cause of:
- Having too few or too many liver enzymes (proteins found in the liver)
- 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
You may need to stop taking some of your medications before your procedure. We have included some common examples below. Don’t stop taking any of your medications without talking with your doctor first.
- If you take medication to thin your blood (sometimes taken 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 how many days until you need to start again. Be sure to share this information with the doctor performing your liver biopsy.
Examples of blood thinners are:
Apixaban (Eliquis®) Dalteparin (Fragmin®) Pentoxifylline (Trental®) Argatroban (Acova®) Dipyridamole (Persantine®) Prasugrel (Effient®) Aspirin Edoxaban (Savaysa®) Rivaroxaban (Xarelto®) Celecoxib (Celebrex®) Enoxaparin (Lovenox®) Sulfasalazine (Azulfidine®, Sulfazine®) Cilostazol (Pletal®) Fondaparinux (Arixtra®) Ticagrelor (Brilinta®) Clopidogrel (Plavix®) Heparin Tinzaparin (Innohep®) Dabigatran (Pradaxa®) Meloxicam (Mobic®) Warfarin (Coumadin®)
- If you take insulin or other medication for diabetes, you may need to change the dose before your liver biopsy. 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. Don’t take more acetaminophen than directed on the label or by your doctor. For more information, read our resource Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs). You can search for this resource on our website, www.mskcc.org/pe, or you can ask your nurse.
- Stop taking any herbal remedies and supplements (such as fish oil, vitamin E, and ginkgo biloba) 7 days before your procedure. For more information, read our resource Herbal Remedies and Cancer Treatment. You can search for this resource on our website, or you can ask your nurse.
If you have an automatic implantable cardioverter-defibrillator (AICD), you will need to get a clearance letter from your cardiologist before your procedure.
You must have someone 18 years or older take you home after your procedure. If you don’t have anyone, call one of the agencies below. They will send someone to go home with you. However, there’s usually a charge for this service, and you will need to provide transportation.
In New York:
Partners in Care 888-735-8913
Prime Care 212-944-0244
In New Jersey:
Caring People 877-227-4649
3 Days Before Your Procedure
You will receive a telephone call from an endoscopy nurse. The nurse will review the instructions in this resource with you and ask you questions about your medical history. They will also review your medications and tell you which to take the morning of your procedure.Back to top
The Day Before Your Procedure
A clerk from the Admitting Office will call you after 11:00 am the day before your procedure. The clerk will tell you what time you should arrive at the hospital for your procedure. If your procedure is scheduled for a Monday, you will be called on the Friday before. If you don’t receive a call by 4:00 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
Between midnight and up until 2 hours before your scheduled arrival time, you may drink a total of 12 ounces of clear liquids (see Figure 1).
Examples of clear liquids include:
- Clear broth, bouillon, or consommé (no particles of dried food or seasonings
- Gelatin, such as Jell-O®
- Clear fruit juices (no pulp), such as white cranberry, white grape, or apple
- Soda, such as 7-Up®, Sprite®, ginger ale, seltzer, or Gatorade®
- Coffee or tea, without milk or cream
- Take only the medications you were instructed to take the morning of your procedure. Take them with a few sips of water. This counts towards your 12-ounce limit.
- Don’t put on any lotion, cream, powder, make-up, or perfume.
- Don’t wear any metal objects. 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.
- A list of the medications you take at home, including patches and creams.
- Medications for breathing problems (such as inhalers), if you take any.
- Medications for chest pain, if you take any.
- A case for your glasses, if you have one.
- Your Health Care Proxy form, if you have completed one.
To reach the garage, turn onto 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 you can walk through that connects the garage to the hospital.
There are also other garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.
Your procedure will be done in the Endoscopy Suites in the main building of MSK. The building is located at 1275 York Avenue, between East 67th and East 68th Streets.
Once you’re in the building, take the M elevator to the 2nd floor and check in at the Presurgical Center (PSC).
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. People 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. Your nurse will place an intravenous (IV) catheter (thin flexible tube) into a vein, usually in your hand or arm. You will receive fluids through the IV, and it will be used later to give you anesthesia (medication to make you sleepy). Your doctor will explain the procedure and answer your questions, if you have them.
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 relaxed and sleepy. Once you’re comfortable, your doctor will give you an injection (shot) of a medication to numb the right side of your abdomen (belly). Some people say they feel pressure when the needle is inserted, but you shouldn’t feel any pain. You will have a small bandage on the biopsy site when it’s finished.Back to top
After Your Procedure
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. Tell your nurse 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.
For the first 24 hours after your biopsy:
- Don’t drink alcoholic beverages
- Keep your biopsy site dry
For at least 3 days after your biopsy:
- Don’t do any strenuous activities
- Don’t lift anything heavier than 10 pounds (4.5 kilograms)
- Don’t vacuum, garden, or play sports
For the rest of the week after your biopsy, you can gradually go back to your normal activities. Don’t lift anything heavier than about 15 pounds (6.8 kilograms) during this time.
Your liver has a lot of blood vessels. Some of these blood vessels were damaged when tissue was removed during your biopsy. For this reason, don’t take any medications that may thin your blood until your doctor tells you it’s safe. Do not take:
- Aspirin and other NSAIDs
- Blood thinners
- Herbal remedies and supplements
- Vitamin E
Read the section “Ask about your medications” for examples of NSAIDs, blood thinners, and herbal remedies and supplements.Back to top
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, or abdomen (belly)
- Swelling or hardness of your abdomen or biopsy site
- Bleeding from the biopsy site
- Blood in your vomit
- Blood in your stool or black tarry stool
- Weakness, faintness, or sweating
- Heart palpitations (feeling like your heart is beating too fast, too hard, or fluttering)
- Any of the following signs of infection or bleeding at the biopsy needle insertion site:
- Increased warmth
- Bluish color