What is Transjugular Liver Biopsy & HVPG?
Transjugular Liver Biopsy (TJLB) is a minimally invasive procedure in which liver tissue is sampled via the jugular vein rather than through the skin over the liver. A catheter is guided from the jugular vein through the hepatic vein inside the liver, and a biopsy needle collects tissue from within the venous system. Any bleeding flows harmlessly back into the vein rather than into the abdomen, making it the safest method for high-risk patients. Simultaneously, the Hepatic Venous Pressure Gradient (HVPG) the gold standard for quantifying portal hypertension can be measured during the same session, giving a complete hepatic assessment in one procedure.
Who is This Procedure For?
Transjugular liver biopsy (TJLB) is specifically recommended for patients in whom conventional percutaneous liver biopsy carries an unacceptably high bleeding risk or is technically not feasible. This includes individuals with severe coagulopathy (INR >1.5 or platelet count <50,000/µL) due to advanced liver disease, haematological disorders, or ongoing anticoagulation therapy. It is also preferred in patients with tense ascites, where large abdominal fluid collections make a percutaneous approach unsafe or difficult. TJLB is indicated in cases of vascular liver lesions such as haemangiomas or highly vascular tumours, where there is a higher risk of haemorrhage. Additionally, it is useful when hepatic venous pressure gradient (HVPG) measurement is required during the same procedure. The technique is often employed following a failed or complicated percutaneous biopsy and is also valuable in liver transplant evaluation, both pre- and post-transplant, particularly when coagulation parameters are abnormal.
How is the Procedure Performed?
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Jugular Vein Access
Under ultrasound guidance, the right internal jugular vein is punctured and a short introducer sheath is placed.
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Hepatic Vein Catheterisation
A catheter is guided under fluoroscopy through the superior vena cava, right atrium, inferior vena cava, and into the right hepatic vein.
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HVPG Measurement
Pressure readings are taken in free and wedged positions. Balloon occlusion venography confirms accurate wedge position.
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Liver Biopsy Sampling
A transjugular biopsy needle passes through the catheter into liver parenchyma. 3–5 passes obtain adequate core tissue for histopathology.
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Post-Procedure Monitoring
Vital signs and ultrasound confirm no haemorrhage. Most patients are discharged the same day or next morning.
