Percutaneous transhepatic endoluminal biliary biopsy with use of a 19-gauge gun

A technique was developed to perform endoluminal biliary biopsy with use of a commercially available 19-g gun. In 18 patients, a biopsy set consisting of an outer 7-F, 50-cm sheath, an inner curved 14-g metal cannula, and a 60-cm, 19-g biopsy gun with a 20-mm throw was employed to obtain tissue from suspicious-appearing biliary strictures via preexisting transhepatic tracts. The endoluminal biopsy was positive for neoplasm in 13 of 18 cases with three false negatives, one true negative, and one patient with insufficient follow-up. One biopsy was complicated by a hepatic artery pseudoaneurysm, which was successfully treated with coil embolization.