Commentary

Endoscopic transpapillary biopsy remains the cornerstone for tissue retrieval from the bile ducts. However, inserting the forceps into the bile duct remains challenging as its tip emerges at a curved angle out of the duodenoscope. Hamada et al. show a simple trick for obtaining targeted biopsies of the intrahepatic bile ducts using a wire-assisted technique. The authors constructed a loop at the tip of the biopsy forceps by passing a nylon thread through the holes in one cup of the forceps. This simple addition of a knotted loop allowed ziplining over a biliary guidewire. The forceps were inserted over the guidewire, successfully obtaining targeted biopsies. Importantly, the authors used a pediatric biopsy forceps, which has a thinner diameter and is easier to insert into the bile ducts. Using this trick with standard forceps may fail.

Publication History

Article published online:
25 February 2020