ENDOSCOPIC TRANS-PAPILLARY BIOPSY USING A SELF-ASSEMBLED DEVICE: THE “TUNNEL TECHNIQUE”

A 77-year-old patient was referred for cholangitis. CT-scan and MR revealed stenosis of the left intrahepatic duct. ERCP confirmed the stenosis and the “tunnel technique” was applied. A 11.5-Fr biliary dilation catheter was used as “tunnel” for biopsy forceps after cutting the tapered tip, leaving the radiopaque marker as reference point. Once obtained biliary cannulation with a 035-inch guidewire, the catheter was advanced in the left intrahepatic duct, close to the stricture. 7-French biopsy-forceps with 7-mm-wide cups were inserted inside the catheter. Biopsies of the stricture were easily performed. Based on histology in favor of cholangiocarcinoma, hepatic resection was scheduled.