Percutaneous transgastric computed tomography-guided biopsy of the pancreas using large needles

AIM：To assess the safety,yield and clinical utility of percutaneous transgastric computed tomography（CT）-guided biopsy of pancreatic tumor using large needles, in selected patients. METHODS：We reviewed 34 CT-guided biopsies in patients with pancreas mass,of whom 24（71%）had a direct path to the mass without passing through a major organ.The needle passed through the liver in one case（3%）.Nine passes（26%）were made through the stomach.These nine transgastric biopsies which used a coaxial technique（i.e.a 17-gauge coaxial introducer needle and an 18-gauge biopsy needle）were the basis of this study.Immediate and late follow-up CT images to detect complications were obtained. RESULTS：Tumor tissues were obtained in nine pancreatic biopsies,and histologic specimens for diagnosis were obtained in all cases.One patient,who had a rare sarco-matoid carcinoma,received a second biopsy.One patient had a complication of transient pneumoperitoneum but no subjective complaints.An immediate imaging study and clinical follow-up detected neither hemorrhage nor peritonitis.No delayed procedure-related complication was seen during the survival period of our patients.CONCLUSION：Pancreatic biopsy can be obtained by a transgastric route using a large needle as an alternative method,without complications of peritonitis or bleeding.