A Refined Technique Of Approach For Bile Duct Biopsy In Endoscopic Retrograde Cholangiopancreatography

Aims Tissue sampling at endoscopic retrograde cholangiopancreatography (ERCP) can be challenging due to low diagnostic yield and high technical demands. Although biopsy is one of the most common technique, ERCP doctors has frequently difficulty to approach a biopsy forceps for biliary lesions. The aim of this study was to describe an easy technique for biliary biopsy, assisted by looped guidewire in beginner ERCP doctors.

Methods A prospective observational study was performed at a tertiary medical center. Between August 2019 and January 2020, 13 patients with proximal biliary duct stricture underwent ERCP with a new biopsy technique. The new technique ‘loop-guidewire assisted forceps approaching’ was as follows;

1. insert the first guidewire through biliary lesion,

2. grasp the tip of another loop tip guidewire by forceps,

3. slowly proceed the loop guidewire through the pre-positioned guidewire until approaching biliary lesion.

This procedure was performed by one beginner ERCP doctor and supervised by one experienced ERCP doctor. We evaluated the usefulness and efficiency by successful rate, diagnostic yield and complication.

Results The success rate of tissue sampling by beginner ERCP doctor was 100 % (13/13). All sample had the adequate quality and volume for histopathology analysis. As a result of biopsy by loop-guidewire assisted forceps biopsy, 11 specimens were confirmed as adenocarcinoma. All patients were finally diagnosed as malignant cancer after that 2 patients were re-examined (Common hepatic duct cholangiocarcinoma 9, Recurred intrahepatic duct cholangiocarcinoma 1, pancreatic cancer with liver metastasis 1, hepatocellular carcinoma 1 and gallbladder cancer 1). The sensitivity was 84.6 % (11/13). There was a mild hyperamylasemia in 2 patients, but no other severe complication.

Conclusions This new technique could reduce the risk of failure and shorten procedure time in ERCP. Especially for beginner ERCP doctors, this technique is useful to perform a safe procedure and minimize the expert’s intervention during ERCP forceps biopsy.

Citation Lee KW, Lee JM, Choi HS et al. eP329 A REFINED TECHNIQUE OF APPROACH FOR BILE DUCT BIOPSY IN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY. Endoscopy 2021; 53: S205.

Publication History

Article published online:
19 March 2021