Using a Sheath in Forceps Biopsies Improves Technical Success Rate

Obtaining intraductal biopsy specimens during ERCP can be challenging. Multiple approaches have been developed to aid tissue acquisition, including wire-guided forceps biopsies and cholangioscopy-guided biopsies. In this randomized controlled study, the authors studied the use of a novel sheath system to facilitate forceps biopsies.

Briefly, the sheath system has both an inner catheter and an outer sheath. The system is advanced over a guidewire to the target location (eg, an intrahepatic stricture) after which the inner catheter is removed. Pediatric forceps are then advanced through the sheath to retrieve targeted biopsy samples. In this study, patients requiring intraductal biopsies were randomly assigned to sheath-guided or conventional fluoroscopy-guided biopsies. Crossover was permitted in cases of biopsy failure.

In total, the study included 90 patients with suspected intraductal malignancy (46 underwent sheath-guided biopsies, and 44 received conventional biopsies). Biopsy forceps were successfully inserted more frequently in the sheath-guided group than in the conventional group (100% vs 92.9%; P = .11) and successfully reached the target site more often with the sheath (100% vs 59.5%; P < .01). Of the 17 patients with unsuccessful conventional biopsies, all successfully crossed over to sheath-guided biopsies. The total biopsy time was similar between the two groups.