Direct intracystic biopsy and pancreatic cystoscopy through a 19-gauge needle EUS (with videos)

BackgroundHistologic diagnosis of cystic pancreatic lesions (CPLs) is often difficult because of the low sensitivity of FNA and brush cytology.ObjectiveTo discover whether obtaining biopsy samples from the cystic wall could increase the diagnostic yield of these lesions.DesignA pilot study including 2 patients with CPLs.SettingEndoscopy unit in a tertiary-care hospital.PatientsTwo women with CPLs located at the pancreatic head.InterventionsOn EUS, biopsy forceps and a SpyGlass fiberoptic were passed through a 19-gauge needle to visualize and obtain samples from the cystic wall.Main Outcome MeasurementsThe histologic assessment was based on the obtained biopsy samples.ResultsBoth CPLs were considered to be mucinous cystoadenomas, because mucinous-like cylindric epithelium without cellular atypia was observed.LimitationsPilot study.ConclusionsObtaining biopsy samples from the wall of a CPL is now feasible. It represents a significant advantage in the diagnostic yield of this type of lesion.