Assessing the risk of unintended intestinal sampling in omental and mesenteric core needle biopsies

Assess the incidence and clinical outcomes of inadvertent bowel sampling with a 17-G coaxial system with an 18-G semi-automatic biopsy needle, omental and mesenteric CT and US-guided biopsy.

In this retrospective study, consecutive patients undergoing omental and mesenteric CT and US-guided biopsy with a 17-G introducer, an 18-G semi-automatic biopsy device performed at a single tertiary academic institution between March 1, 2005, and March 1, 2024, were included to assess the incidence and clinical outcomes of inadvertent bowel sampling. Descriptive statistics were used.

Among 265 biopsies, there were six cases (6/265, 2.3%) with inadvertent bowel sampling identified on pathology. The median age was 83.5 years (IQR: 65.6-85.3) in patients with inadvertent bowel sampling, and 66 years (IQR: 58-74) in patients without inadvertent bowel sampling, p = 0.02. In patients with inadvertent bowel sampling, 4/6 (66.7%) of biopsies were from mesentery, in contrast to the patients without inadvertent bowel sampling, with 210/259 (81.1%) omental biopsies, p: 0.04. The bowel mucosa on pathology was arising from the colon in 3/6 (50%), the duodenum in 2/6 (34%), and the distal ileum in 1/6 (17%). All patients underwent a standard post-procedure observation time of 1 hour, during which no signs or symptoms of clinically significant bowel perforations were identified. No patients were admitted after the procedure, and no patients required admission within 30 days after the procedure for bowel-related indications.

Inadvertent bowel sampling during percutaneous omental and mesenteric biopsy with a 17 G introducer, and an 18 G semi-automatic needle is a rare, but likely benign event, even in patients without bowel preparation or antibiotic coverage.

Question The incidence and clinical consequences of unintended intestinal sampling in percutaneous omental and mesenteric core needle biopsies are unknown. Findings Inadvertent bowel sampling occurred in 2.3% of omental and mesenteric biopsies. No clinically significant complication was observed, despite the lack of bowel preparation or antibiotic prophylaxis. Clinical relevance Inadvertent bowel sampling is rare, more common in elderly patients and mesenteric biopsies, and likely benign, even without preparatory measures. However, given the potential for serious complications reported in the literature, meticulous technique remains crucial to minimizing the risk.