Percutaneous transgastric computed tomography-guidedbiopsy of the pancreas using large needles

Abstract

Pancreatic biopsy can be obtained by a transgastric route using a large needle as an alternative method, without complications of peritonitis or bleeding.

Methods to Obtain Percutaneous Access to Difficult-to-Reach Masses and Collections in the Abdomen and Pelvis

“…48 While the smallest caliber needle is generally recommended when using an approach through the stomach, Tseng et al demonstrated that transgastric biopsy of the pancreas was safe using 17-gauge guide needle with no major complications in 34 biopsies. 49 Although no complications were seen in this series, complications have been described, especially in pancreatic biopsies where cases of pancreatitis and bacteremia have been reported. 50,51 Transgastric drains also have been described in the setting of acute and chronic peripancreatic collections from pancreatitis.…”

Computed tomography-guided percutaneous biopsy of pancreatic masses using pneumodissection

“…Several techniques have been described for percutaneous biopsy of pancreatic tumors where direct access to the lesion is not feasible, with good results and low rates of complications (12) . Such techniques include transgastric and transhepatic biopsies and hydrodissection maneuvers.…”

“…Recently, a series of studies published in Brazil have highlighted the relevance of interventional radiology in the diagnosis and treatment of diseases in different compartments of the body (3)(4)(5)(6)(7)(8)(9)(10) . Computed tomography (CT)-guided percutaneous biopsy is a safe and well-established technique, with high accuracy in the diagnosis of focal pancreatic lesions and low rate of complications (11,12) .…”

Abscess Drainage

“…Avoiding vital anatomical structures such as sizable arteries and veins lessens the bleeding risks and avoids pseudoaneurysm formation. Where it is acceptable to traverse the stomach or intestines for percutaneous biopsy of deep lesions, 16 it is usually not acceptable to place external drainage catheters through a solid organ or hollow viscus. Exceptions do exist, such as the occasional placement of drains through the liver, the transgastric approach (endoscopically and percutaneously) to treat pancreatic fluid collections, 17 the transrectal or transvaginal approach to drain pelvic abscesses, and the placement of cecostomy tubes for colonic decompression.…”