Traditionally, percutaneous ultrasound (US) guided bowel mass biopsies are avoided in favour of endoscopic or surgical biopsies. Endoscopy cannot easily reach between duodenojejunal flexure and terminal ileum and lesions not involving the mucosa may not be amenable to endoscopic biopsy. Surgical biopsies are invasive. We report our technique and outcomes of US guided bowel wall mass biopsy.
14 year retrospective review of US guided bowel wall mass biopsies at a single paediatric institute. This study was registered with the audit department and specific ethical approval was not required. Data sources include an Interventional Radiology database, electronic patient records and PACS. Data are quoted as median (range) unless indicated. Following MDT review and parental consent, biopsies were performed under US guidance using a semi-automated side notch needle (Temno EvolutionTM).
20 US guided bowel mass (16 small bowel, 4 large bowel) biopsies were performed in 19 patients (16 male). Patient age was 6yr6m (1yr10m – 17yr) and weight 22kg (10.2 – 48.4). A percutaneous co-axial technique followed by tract embolization with Gelfoam® was used for 19/20 biopsies. One trans-anal, non-co-axial, biopsy was performed. 9 (2 – 15) cores were obtained at each biopsy. Technical success and diagnostic yield was 100% (Burkitt lymphoma (11), post-transplant lymphoproliferative disorder (3), large B-cell lymphoma (5), necrotising granulomatous inflammation (1)). 3/20 biopsies contained mucosa. There were no complications. 14/20 had no other lesion which potentially could be biopsied. 19/20 had a bone marrow aspirate and/or trephine within 2 weeks, only 2 of which were diagnostic (both Burkitt lymphoma). 2 endoscopic biopsies were performed within a month of the US guided biopsy, showing focally active colitis only.
US guided bowel wall mass biopsy can be performed safely, has a high diagnostic rate and avoids major surgical procedures thus helping recovery and management of complex patients.