LIVER BIOPSY

liver411

What is a Liver Biopsy?
Who needs a liver biopsy?
How is a Liver Biopsy done?
What are the risks associated with a Liver Biopsy?
What happens after a Liver Biopsy?

WHAT IS A LIVER BIOPSY?

A liver biopsy is a procedure by which a thin core of liver tissue is
obtained for analysis under a microscope. It is probably the oldest of all
the procedures done by your gastroenterologist. It is said to have been
first performed by Paul Erlich in 1883. The basic technique has been refined
since then. These refinements have decreased the risk to a degree that a
liver biopsy is commonly done on an outpatient basis.

WHO NEEDS A LIVER BIOPSY?

Since liver biopsy is considered the "gold standard" its indications are
many and varied. The clinician uses the information obtained to guide his
treatment or assess the extent and severity of liver damage. Some of the
more common indications are:

a.Chronic viral hepatitis like Hepatitis B and Hepatitis C.
b.Unexplained liver enlargement and liver tests.
c.Alcohol induced liver disease.
d.Drug induced liver damage.
e.Space occupying liver lesions like tumors and cancers.
f.Systemic diseases and infections affecting the liver.
g.After liver transplantation for rejection and other complications.
h.Assessment of response to treatment.
i.Storage diseases of the liver.

HOW IS A LIVER BIOPSY DONE?

Most liver biopsies are done on an outpatient basis i.e. the patient stays
in the hospital for half a day. The doctor orders tests to check bleeding
and clotting times. Patient's blood group is known and blood available if
needed. All recent medications are reviewed. Aspirin and aspirin like
medications should have been stopped. Under full aseptic precautions the
right side of the chest is cleaned and numbed using local anesthesia.
Breathing techniques are practiced with the patient. Using a long fine
needle a core of liver tissue is obtained. The actual process takes only 1-2
seconds. This process is repeated and another specimen obtained. A dressing is applied and the patient lies on his/her right side for about 2 hours and on the back for another 2 hours. After about 4-6 hours a blood sample is drawn. If this sample is similar to the one drawn before the biopsy, no bleeding has occurred and the patient is discharged home. The patient spends the rest of the day resting at home. He/She should not be alone and should have easy access to a phone and a hospital.

Sometimes a liver biopsy is done by a Radiologist using an ultrasound or CT scan to guide the needle(US or CT guided liver biopsy). In patients with a bleeding disorder it can be done by a catheter inserted into a neck vein and advanced into the liver (transjugular liver biopsy). Rarely it has to be
done via a tube inserted into the abdomen (laparoscopic liver biopsy). Your
Borland-Groover Clinic physician will be able to decide which technique is
best for you.

WHAT ARE THE RISKS ASSOCIATED WITH A LIVER BIOPSY?

A liver biopsy is by and large a safe procedure. The risk of dying is about
1 in 10,000 procedures. The various reported complications are.

a.Bleeding: This is an uncommon but serious complication. It is
usually controlled by observation and blood
transfusion, but may require surgery to stop it.
b.Injury to the Gallbladder.
c.Bleeding into the bile ducts.
d.Injury to the kidney and colon.
e.A connection between a vein and an artery called a fistula.
f.Irritation of the covering of the lung or liver (Pleurisy or
perihepatitis).

WHAT HAPPENS AFTER A LIVER BIOPSY?

The day after a liver biopsy the patient can resume his normal lifestyle.
Over the next week the liver specimen undergoes extensive evaluation under a microscope by a pathologist skilled in liver diseases. Special stains (dyes) are used to highlight various aspects of the liver. This result is made
available to your gastroenterologist who uses this information for
diagnosis, treatment decisions and to assess the prognosis.

This is a brief and simplified overview of a liver biopsy. If you have any
questions or clarifications please contact physician who will be happy to
discuss it further with you.

yuer

hepatitis b drugs watch, for your information
PHASE I PHASE II PHASE III
Drugs are being tested for safety on volunteer test subjects Drugs have passed phase one, and are being tested for dosage and side effects Drugs in Phase III stage are being tested for effectiveness, to determine how well they really work to treat the disease.

  FAMILY / DRUG NAME MECHANISM COMPANY* WEBSITE STATUS
Interferons Mimic naturally-occurring, infection-fighting immune substance produced in the body
Interferon alpha2b (Intron A®) Immunomodulator Schering-Plough
Madison, NJ www.schering.com FDA Approved
1991
There are other brands of interferon approved for HCV treatment, but they have not been FDA-approved for HBV: Wellferon® (Glaxo), Roferon® (Hoffman-La Roche), and Infergen® (Amgen)
Nucleoside Analogues -  Interfere with the viral DNA polymerase enzyme used for hepatitis B virus reproduction
Lamivudine
(Epivir-HBV®) Inhibits viral DNA polymerase GlaxoSmithKline,RTP, N.C. www.gsk.com FDA Approved
1998
Adefovir Dipivoxil Inhibits viral DNA polymerase Gilead Sciences
Foster City, CA www.gilead.com Phase III
Entecavir  Inhibits viral DNA polymerase Bristol-Myers Squibb, Princeton, N.J. www.bms.com Phase III
FTC (Coviracil®) Inhibits viral DNA polymerase Triangle, RTP, N.C. www.tripharm.com Phase III
DAPD (DXG)  Inhibits viral DNA polymerase Triangle, RTP, N.C. www.tripharm.com Phase II
L-FMAU (Clevudine®) Inhibits viral DNA polymerase Triangle, RTP, N.C. www.tripharm.com Phase II
AM365  Inhibits viral DNA polymerase Amrad, Victoria, Australia www.amrad.com.au Phase II, Australia & Asia
LdT  (Telbivudine) Inhibits viral DNA polymerase Idenix, Boston, MA www.idenix.com Phase III
monval-LdC (Valtorcitabine)   Inhibits viral DNA polymerase Idenix, Boston, MA www.idenix.com Phase II
ACH-126,443          (L-Fd4C) Inhibits viral DNA polymerase Achillion New Haven, CT www.achillion.com Phase II (Central & Eastern Europe)
MCC478  Nucleoside analog "prodrug" Eli Lilly & Co.,
Indianapolis, IN www.lilly.com Phase I (Germany)
Racivir (RCV) Inhibits viral DNA polymerase Pharmasset, Tucker, GA www.pharmasset.com IND Filed 5/02
Fluoro-L and D nucleosides Inhibits viral DNA polymerase Pharmasset, Tucker, GA www.pharmasset.com Preclinical
Robustaflavone  Inhibits viral DNA polymerase Advanced Life Sciences, Woodbridge IL www.advancedlifesciences.com Preclinical
ICN 2001-3   Inhibits viral DNA polymerase ICN, Costa Mesa, CA www.icnpharm.com Preclinical
Non-Nucleoside Anti-virals -  Interfere with proteins involved in viral reproduction
Bam 205   "Small Molecule" Novelos, Newton, MA http://novelos.com Phase II/III China
XTL-001   Human monoclonal antibodies XTL Biopharm, Rehovot, Isreal www.xtlbio.com Phase II, Israel & USA
Imino-Sugars (Nonyl-DNJ) *Discovered by HBF Scientists Protein folding inhibitor Synergy, Edison, N.J. Tel: 732.302.1111 Preclinical
HepBzyme  Nuclease resistant ribozyme Ribozyme, Boulder, Co www.rpi.com Preclinical
Non-Interferon Immune Enhancers -  Boost T-cell infection-fighting immune cells and natural interferon production
HE2000  NEW Hollis-Eden San Diego, CA www.holliseden.com Phase II, Singapore
Theradigm Immune stimulator Epimmune,
San Diego, CA www.epimmune.com Phase II
EHT899 Oral Viral Protein Enzo Biochem, Inc., New York, N.Y. www.enzo.com Phase II (Israel)
Thymosin alpha-1
(Zadaxin®) Immune stimulator SciClone
San Mateo, CA www.sciclone.com 1. Phase II with Lamivudine
2.Orphan drug approval in USA
HBV DNA Vaccine   Immune stimulator PowderJect, Oxford, U.K. www.powderject.com Phase I
HBV DNA Vaccine Immune stimulator Jefferson Center, Doylestown, PA 215.489.4949 Preclinical
HBV Antigen Oral Tolerance OraGen,
Philadelphia, PA 215.923.5124 Preclinical
Post-Exposure and/or Post-Liver Transplant Treatment
BayHep B® HBV Immuneglobulin Bayer U.S.,
Pittsburgh, PA www.bayer.com FDA Approved 1977
Nabi-HB® HBV Immuneglobulin Nabi, Boca Raton, FL www.nabi.com FDA Approved
1999
Anti-hepatitis B   HBV Immuneglobulin Cangene, Ontario, Canada www.cagene.com FDA Filing 2001

  Hepatitis Vaccine Watch Download a PDF
version of this chart

    NAME TYPE VACCINE COMPANY WEBSITE STATUS
Hepatitis B Vaccines - Recommended for those at risk and patients with chronic HCV
Engerix B Recombinant HBV GlaxoSmithKline, Philadelphia,  PA www.gskvaccines.com Market, USA
Recombivax HB Recombinant HBV Merck, West Point, PA www.merck.com Market, USA
GenHevac B Recombinant HBV Aventis Pasteur, Lyons, France www.aventispasteur.com Market, Europe
Hepacare
(formerly, Hepagene) HBV preS1, preS2 PowderJect, Oxford, U.K. www.powderject.com Market, Europe
Bio-Hep B HBV S, preS1, PreS2 Biotech. Gen. Corp., Iselin, N.J. www.btgc.com Market, Israel
Hepatitis A Vaccines - Recommended for those at risk and patients with chronic HBV and HCV
Havrix Inactivated HAV GlaxoSmithKline www.gskvaccines.com Market, USA
VAQTA Inactivated HAV Merck www.merck.com Market, USA
Avaxim Inactivated HAV Aventis Pasteur www.aventispasteur.com Market, Europe
Combination Hepatitis Vaccines
TwinRix (Adult) HBV and HAV GlaxoSmithKline www.gskvaccines.com Market, USA
Comvax (Pediatric) HBV and HiB Merck www.merck.com Market, USA
Hexavac (Pediatric) HBV, DTP, HiB, Polio Aventis Pasteur www.aventispasteur.com Market, Europe
Hepatitis Vaccines in Development
Hep B Vaccine ISS-linked to HBsAg Dynavax Technology, Berkley, CA www.dynavax.com Phase I/II
Hep B
DNA Vaccine Px
HBV DNA Vaccine PowderJect www.powderject.com Phase I

  
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