Namely, the endoscope goes down the esophagus, then…where? Through the common bile duct via the duodenum? That seems like a pretty convoluted path for a scope, but I can’t figure out how else one could access the liver.
It sounds like you are asking how a liver biopsy is done using an endoscope and a trans-oral route.
Here’s an article describing the use of an endoscope to visualize inside the peritoneal cavity as well as biopsy the liver using a trans-gastric route. This means the flexible endoscope goes down through the mouth and esophagus into the stomach. An incision is made in the stomach for the endoscope, and it’s through this incision the visualization into the peritoneal cavity and (liver, in this case) biopsy are done.
An endoscope is a fairly broad term; as you are aware, percutaneous (trans-abdominal) approaches for inserting the scope are much more common. In some situations such as the morbidly obese, the thinking is that an approach trans-orally might be preferable for the least invasive access.
Thanks, Chief Pedant. My brother recently underwent such a procedure, and I couldn’t figure out how the endoscope gets to the liver without an incision to get it outside the stomach. So the answer is “It doesn’t.”
I don’t know why he had a trans-oral endoscopy. It wouldn’t be because he’s morbidly obese. Perhaps because of his underlying disease (Waldenström macroglobulinemia).
I had 2 liver biopsies the old way, from outside on the right side of my body. I was sore for about 1 day after them.
Are you sure you don’t mean transvenous? I ask since I had a percutaneous liver biopsy about 4 years ago. The doctor mentioned that since my blood didn’t clot so well at the time he might have to resort to the transvenous version since that less problems with bleeding. (Basically they go in your neck, down a vein until they reach the liver and then cut into the liver from the vein. The only place for the liver to bleed is into a vein so the only place they have to worry about blood loss is one hole in the neck.)
Nope, definitely an endoscope down the throat.
After reading these descriptions, I am much happier about the much quicker and easier “poke a hole in my abdomen and snip chunks out of my liver” method that I went through a few years ago. And that resulted in 4 hours of agony from the hole in my diaphragm that 4 grains of morphine and 2 Tylenol with codeine didn’t touch.
Wait, that’s how they did yours? Mine was a very quick jab between the ribs. (Well first they loaded me up with an arm load of sedatives so I didn’t care anymore. Then a little lidocane and then the fun.) At least in my case it wasn’t bad at all. On the plus side now I can tell people how one day I went into the city when some guy walked up to me and stabbed me right between the ribs. (And all the nurse gave me to take care of it was a band aid and then kicked me out of the hospital after a few hours. It’s my in joke.) Did they mess up and hit you in the diaphragm?
On the contrary - my sense is that morbid obesity might well be the reason. In fact, I’m pretty sure that morbid obesity is a contraindication to percutaneous liver biopsy (through the skin and muscle of the abdominal wall), i.e. difficulty of the biopsy needle actually reaching the liver and not simply coming to a stop in the massive fat deposits deep to the abdominal wall in people who are morbidly obese. That being said, I can’t imagine that it’s very easy reaching the liver by the endoscopic route either (although the authors of the article in Chief Pedant’s link explicitly stated that three patients were morbidly obese).
I may be mistaken here, but my impression on reading her reply to Chief Pedant is that freckafree’s brother’s reason for having endoscopic surgery wasn’t likely to have been morbid obesity simply because her brother isn’t morbidly obese.
One might consider reasons other than morbid obesity for a trans-oral endoscopic approach, including exactly what part of the liver (or other anatomy) needs a biopsy. Typically a CT or MRI would give an endoscopist the best idea of how to approach a particular region by the least invasive route. If it were the case that a needle biopsy (or equivalent) could be done by a trans-oral route because the part of liver needing biopsy happened to be exactly adjacent to the gut, a trans-oral route might be chosen. Such a procedure would not require an incision in the gut itself for full access of the entire scope or access port.
I also understood freckafree to mean the sibling in question in the OP was not himself obese…
Hmm, that actually would make some sense. I looked up that disease the OP mentioned and it’s a type of blood cancer. I wonder if they were actually trying to biopsy a specific tumor on the liver or something. (To contrast that with my biopsy really they were just looking to see if they could determine the origin of my liver damage with a generic sample so any part of it was good to test. The annoying part was after putting me through it they learned nothing except I don’t have cirrhosis.)
Heck, I didn’t even get offered sedatives. I would have liked something to help while away the hours (6) lying on my side afterwards. I finished two books, ran my ipod flat, and then got really bored.
Si
Man, they didn’t cut you any breaks did they? I was probably in recovery for 6 as well but it took hours for the sedatives to wear off so it didn’t seem that long. (They didn’t knock me out or anything. I’m not sure if they even gave me any IV pain medication. Pretty much I layed there for hours, had lunch then went home.) Anyway found this link.
http://digestive.niddk.nih.gov/ddiseases/pubs/liverbiopsy/
Looks like the idea of a specific area might be the answer. (Or the cancer.)
Could be. A CT scan had already revealed a blockage. In addition to doing the biopsy, they put in a stent. I forgot to mention that.
Mine went in under the ribs, just to the right of the center line of my torso. They didn’t actually mess anything up, it was just the way my liver is located and the area they were getting the samples from caused them to clip the edge of the diaphragm. It was one of the rare things that can happen when they do a percutaneous liver biopsy. And even that doesn’t always result in the nerve pain. I was just one of the lucky ones.
Another possibility is that the needle can hit a nerve when the snip out the section. It doesn’t happen too often, because there are not that many nerves running through the liver. It really hurts when that happens. A lot. I was really lucky that day. 