Transjugular Liver Biopsy (TJLBx)
Date issued: November 2024
For review: November 2026
Ref: B-300/RA/Imaging/Transjugular Liver Biopsy TJLBx V2
PDF: Transjugular Liver Biopsy TJLBx.pdf [pdf] 197KB
This leaflet tells you about having a transjugular liver biopsy. It explains what is involved and what the possible risks are. It is not meant to replace informed discussion between you and your doctor but can act as a starting point for such discussions. If you have any questions about the procedure, please ask the doctor who has referred you or the department which is going to perform it.
Referral and consent
The referring clinician should have discussed the reasons for this examination with you in the clinic and you should make sure that you understand these before attending. You will be referred to an Interventional Radiologist for this procedure.
Interventional Radiologists are doctors who have trained and specialised in imaging and x-ray treatments.
Before the procedure you will need to sign a consent form. This is a legal requirement and ensures that you are fully informed about your procedure.
If after discussion with your hospital doctor or Radiologist, you do not want this examination then you can decide against it. If the radiologist feels that your condition has changed or that your symptoms do not indicate such a procedure is necessary, then they will explain this to you and communicate with the referring clinician. You will return to your referring clinician for review.
At all times the radiologist and referring clinician will be acting in your best interests.
What is a Transjugular Liver Biopsy?
A liver biopsy is a procedure that involves taking a tiny specimen of the liver for examination under a microscope. In most cases, a liver biopsy is taken through the skin by passing a fine needle through into the liver.
A Transjugular Lliver Biopsy (TJLBx) is an alternative way of obtaining the liver specimen by passing the needle through the vein in the neck (jugular vein). This method is used in patients who have abnormal clotting of the blood or fluid collecting within abdomen. This technique is to reduce the risk of bleeding after the biopsy.
Why do you need a Transjugular Liver Biopsy?
The doctors looking after you have decided that you need a liver biopsy to obtain more information about your liver problem. The information gained from the biopsy will help the doctors in the treatment of your condition.
Are there any risks?
Transjugular Liver Biopsy is a safe procedure, but as with any medical procedure there are some risks and complications that can arise. The overall risk of a problem requiring further treatment is low (1–2%).
The main risk is bleeding after the biopsy. However, a TJLBx has a lower risk of bleeding than a conventional liver biopsy taken through the side of the abdomen.
If you are pregnant or suspect that you may be pregnant you should notify the department. A baby in the womb may be more sensitive to radiation than an adult. There is no problem with something like an x-ray of the hand or chest because the radiation field is at a safe distance from the foetus. However, special precautions are required for examinations where the womb is in, or near, the beam of radiation. If you are a female of childbearing age the radiographer will ask you if there is any chance of you being pregnant before the examination begins and you will be asked to sign a form. If there is a possibility of pregnancy, then your case will be discussed with the team looking after you to decide whether or not to recommend postponing the investigation.
There will be occasions when diagnosing and treating your illness is essential for your health and where the benefit clearly outweighs the small radiation risks. The procedure may go ahead after discussing all the options with you.
Are you required to make any special preparations?
A TJLBx is usually carried out as a day case procedure under local anaesthetic and sedation if required.
If you have a morning appointment, you will be asked to have nothing to eat from midnight although you may still drink water up to 6am then sips of water for the 2 hours before your examination.
If you have an afternoon appointment you may eat normally up to 6am and then water only up to 10am with sips of water for the 2 hours before your examination.
If your blood clotting is abnormal, you may be given special blood transfusions to try and correct this. If you have any concerns about having blood transfusions, you should discuss these with your doctor.
If you have any allergies or have previously had a reaction to the dye (contrast agent), you must tell the radiology staff before you have the test.
Who will you see?
A specially trained team led by an Interventional Radiologist within the radiology department. Interventional Radiologists have special expertise in reading the images and using imaging to guide catheters and wires to aid diagnosis and treatment.
Where will the procedure take place?
If you are having the procedure as a day case, then you will attend PIU/Postbridge ward prior. You will be asked to get undressed and put on a hospital gown. A small cannula (thin tube) will be placed into a vein in your arm. You may require a fluid drip to help your kidney function before the procedure.
Our porters will collect you and bring you to the interventional radiology suite which is located within
X-ray East. This is similar to an operating theatre into which specialised X-ray equipment has been installed.
What happens during a TJLBx?
The procedure is performed using local anaesthetic and often sedation. The skin at the side of the neck will be swabbed and covered with sterile towels. The skin will be numbed with local anaesthetic. Once the skin is numb, a small tube (catheter) is inserted into the vein at the side of the neck. An X-ray machine is used to guide the catheter into the vein in the liver and then to guide the needle into the liver.
Usually, two to three biopsy specimens are taken.
Will it hurt?
When the local anaesthetic is injected, it will sting for a short while, but this soon wears off. When the catheter is placed in the liver, you may get a dull ache in the right shoulder. This will go away once the tube has been removed. Some people feel a sharp pinch inside the abdomen as the biopsy is taken, but this will only last 1–2 seconds.
How long will it take?
Every patient's situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be. As a guide, expect to be in the X-ray department for about an hour altogether.
What happens afterwards?
You will be taken back to your ward on a trolley. Nurses on the ward will carry out routine observations, such as taking your pulse and blood pressure, to make sure that there are no problems. You will generally stay in bed for a few hours, until you have recovered. Assuming you are feeling well, you will normally be discharged the same day.
If you have had sedation, then you will need someone to drive you home.
Other Risks
A liver biopsy is a very safe procedure but as with any procedure or operation complications are possible. We have included the most common risks and complications in this leaflet.
We are all exposed to natural background radiation every day of our lives. This comes from the sun, food we eat, and the ground. Each examination gives a dose on top of this natural background radiation.
Any exposure to ionising radiation (e.g. X-rays) has the potential to cause cancer later in life. This is much lower than the risk we all have of developing cancer in our life of ~ 1 in 3 and will be considered by the doctor before your procedure.
For information about the effects of X-rays read the publication: “X-rays how safe are they” on the Health Protection Agency.
Finally
Some of your questions should have been answered by this leaflet but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure.
Contact
Interventional Radiology Department
01752 432063 – Bookings Clerk
01752 430838 – IR Co-ordinator
Additional Information
Bus services:
There are regular bus services to Derriford Hospital. Please contact:
Car parking:
Hospital car parking is available to all patients and visitors. Spaces are limited so please allow plenty of time to locate a car parking space. A charge is payable.
Park and Ride:
Buses (PR3 and 101) run from the George Junction Park and Ride Mon-Fri (except Bank Holidays) every 15/20 mins from 6:45am. The last bus leaves the hospital at 7:14pm. The 101 runs on a Saturday, every 15 mins from 7.22am. Last bus leaves the hospital at 6:12pm.
Plympton Park and Ride (52) runs from Coypool Park and Ride.
Parking is free although you will need to purchase a ticket to travel on the bus.
Patient Transport:
For patients unable to use private or public transport please contact TAPS 0845 0539100
Comments and Suggestions
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