From the Guidelines
A gastroenterologist should be consulted to perform an endoscopic ultrasound (EUS) guided biopsy of the pancreas. Gastroenterologists receive specialized training in advanced endoscopic procedures, including EUS, which combines endoscopy with ultrasound technology to visualize and sample pancreatic tissue 1. In some medical centers, interventional gastroenterologists who have completed additional fellowship training in advanced endoscopic procedures may be specifically designated for these complex procedures. The procedure involves inserting an endoscope with an ultrasound probe through the mouth into the digestive tract, allowing precise visualization of the pancreas and surrounding structures. This enables accurate needle placement for tissue sampling while minimizing the risk of complications. EUS-guided biopsy is preferred over percutaneous approaches for pancreatic lesions because it offers better visualization, reduced risk of tumor seeding, and the ability to assess nearby blood vessels and lymph nodes simultaneously 1.
Some key points to consider when performing an EUS-guided biopsy of the pancreas include:
- The patient will need to fast for at least 6-8 hours before the procedure
- The patient should discuss any blood-thinning medications with their physician beforehand
- EUS-guided FNA biopsy is preferable to CT-guided FNA in patients with resectable disease because of the much lower risk for peritoneal seeding with EUS-FNA compared with the percutaneous approach 1
- A negative biopsy should be confirmed by at least 1 repeat EUS biopsy
- In patients without obstructive jaundice at initial presentation, EUS-FNA is highly accurate and reliable for ruling in malignancy 1.
It is essential to involve multidisciplinary consultation in all diagnostic and surgical management decisions 1.
From the Research
Specialty Consultation for Endoscopic Ultrasound Guided Biopsy
To perform an endoscopic ultrasound guided biopsy of the pancreas, the specialty that should be consulted is:
- Gastroenterology, as gastroenterologists are trained to perform endoscopic procedures, including endoscopic ultrasound (EUS) guided biopsies 2, 3, 4
Relevant Procedures and Techniques
The procedures and techniques relevant to this consultation include:
- Endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) and fine needle biopsy (FNB) 2, 3, 4
- EUS guided tissue sampling for pancreatic lesions 2, 5
Training and Competence
Gastroenterologists who perform EUS guided biopsies should have:
- Achieved competence in upper gastrointestinal endoscopy before training in diagnostic EUS 4
- Completed a minimum of 250 supervised EUS procedures, including at least 75 EUS-FNA/FNBs 4
Advantages and Indications
The advantages and indications for EUS guided biopsies include: