Subscribe to RSS
DOI: 10.1055/s-0044-1792138
Percutaneous Biopsy and Drainage of the Pancreas

Abstract
Percutaneous biopsy and drainage of pancreatic lesions, though less frequent due to advancements in endoscopic techniques, remain vital skills for interventional radiologists. This review details the indications, options, approaches, and technical considerations for pancreatic biopsy and (peri)pancreatic fluid drainage by examining a comprehensive range of literature. The importance of a multidisciplinary approach is emphasized to ensure optimal patient care and outcomes, highlighting current best practices and recent advancements.
Keywords
pancreatic biopsy - pancreatic cancer - pancreas rejection - percutaneous drainage - interventional radiologyPublication History
Article published online:
10 December 2024
© 2024. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Thompson JS, Murayama KM, Edney JA, Rikkers LF. Pancreaticoduodenectomy for suspected but unproven malignancy. Am J Surg 1994; 168 (06) 571-573 , discussion 573–575
- 2 Abraham SC, Wilentz RE, Yeo CJ. et al. Pancreaticoduodenectomy (Whipple resections) in patients without malignancy: are they all ‘chronic pancreatitis’?. Am J Surg Pathol 2003; 27 (01) 110-120
- 3 Smith CD, Behrns KE, van Heerden JA, Sarr MG. Radical pancreatoduodenectomy for misdiagnosed pancreatic mass. Br J Surg 1994; 81 (04) 585-589
- 4 Suzuki R, Irisawa A, Bhutani MS. et al. An automated spring-loaded needle for endoscopic ultrasound-guided abdominal paracentesis in cancer patients. World J Gastrointest Endosc 2014; 6 (02) 55-59
- 5 Masuda S, Koizumi K, Shionoya K. et al. Comprehensive review on endoscopic ultrasound-guided tissue acquisition techniques for solid pancreatic tumor. World J Gastroenterol 2023; 29 (12) 1863-1874
- 6 Facciorusso A, Del Prete V, Buccino VR, Purohit P, Setia P, Muscatiello N. Diagnostic yield of Franseen and fork-tip biopsy needles for endoscopic ultrasound-guided tissue acquisition: a meta-analysis. Endosc Int Open 2019; 7 (10) E1221-E1230
- 7 Elhanafi S, Mahmud N, Vergara N. et al. Comparison of endoscopic ultrasound tissue acquisition methods for genomic analysis of pancreatic cancer. J Gastroenterol Hepatol 2019; 34 (05) 907-913
- 8 Yousri M, Abusinna E, Tahoun N, Okasha HH, El-Habashi AH. A comparative study of the diagnostic utility of endoscopic ultrasound-guided fine needle aspiration cytology (EUS-FNA) versus endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) in pancreatic and non-pancreatic lesions. Asian Pac J Cancer Prev 2022; 23 (06) 2151-2158
- 9 Ishiwatari H, Sato J, Fujie S. et al. Gross visual inspection by endosonographers during endoscopic ultrasound-guided fine needle aspiration. Pancreatology 2019; 19 (01) 191-195
- 10 Iwashita T, Yasuda I, Mukai T. et al. Macroscopic on-site quality evaluation of biopsy specimens to improve the diagnostic accuracy during EUS-guided FNA using a 19-gauge needle for solid lesions: a single-center prospective pilot study (MOSE study). Gastrointest Endosc 2015; 81 (01) 177-185
- 11 Kaneko J, Ishiwatari H, Sasaki K. et al. Macroscopic on-site evaluation of biopsy specimens for accurate pathological diagnosis during EUS-guided fine needle biopsy using 22-G Franseen needle. Endosc Ultrasound 2020; 9 (06) 385-391
- 12 Kaneko J, Ishiwatari H, Sasaki K. et al. Macroscopic visible core length can predict the histological sample quantity in endoscopic ultrasound-guided tissue acquisition: multicenter prospective study. Dig Endosc 2022; 34 (03) 622-631
- 13 Planz V, Galgano SJ. Percutaneous biopsy and drainage of the pancreas. Abdom Radiol (NY) 2022; 47 (08) 2584-2603
- 14 Sundaram M, Wolverson MK, Heiberg E, Pilla T, Vas WG, Shields JB. Utility of CT-guided abdominal aspiration procedures. AJR Am J Roentgenol 1982; 139 (06) 1111-1115
- 15 Tseng HS, Chen CY, Chan WP, Chiang JH. Percutaneous transgastric computed tomography-guided biopsy of the pancreas using large needles. World J Gastroenterol 2009; 15 (47) 5972-5975
- 16 Tyng CJ, Almeida MF, Barbosa PN. et al. Computed tomography-guided percutaneous core needle biopsy in pancreatic tumor diagnosis. World J Gastroenterol 2015; 21 (12) 3579-3586
- 17 D'Onofrio M, De Robertis R, Barbi E. et al. Ultrasound-guided percutaneous fine-needle aspiration of solid pancreatic neoplasms: 10-year experience with more than 2,000 cases and a review of the literature. Eur Radiol 2016; 26 (06) 1801-1807
- 18 Liu J, Huang W, Wang S. et al. Comparison of core needle biopsy and fine-needle aspiration methods in CT-guided percutaneous sampling of pancreatic tumors. J Cancer Res Ther 2023; 19 (04) 904-909
- 19 Chai WL, Kuang XF, Yu L. et al. Percutaneous ultrasound and endoscopic ultrasound-guided biopsy of solid pancreatic lesions: an analysis of 1074 lesions. Hepatobiliary Pancreat Dis Int 2023; 22 (03) 302-309
- 20 Patel IJ, Rahim S, Davidson JC. et al. Society of Interventional Radiology Consensus Guidelines for the periprocedural management of thrombotic and bleeding risk in patients undergoing percutaneous image-guided interventions - Part II: Recommendations: Endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol 2019; 30 (08) 1168-1184.e1
- 21 Redfield RR, Kaufman DB, Odorico JS. Diagnosis and treatment of pancreas rejection. Curr Transplant Rep 2015; 2 (02) 169-175
- 22 Mederos MA, Reber HA, Girgis MD. Acute pancreatitis: a review. JAMA 2021; 325 (04) 382-390
- 23 Banks PA, Bollen TL, Dervenis C. et al; Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis – 2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62 (01) 102-111
- 24 Nawaz H, Mounzer R, Yadav D. et al. Revised Atlanta and determinant-based classification: application in a prospective cohort of acute pancreatitis patients. Am J Gastroenterol 2013; 108 (12) 1911-1917
- 25 Singh VK, Bollen TL, Wu BU. et al. An assessment of the severity of interstitial pancreatitis. Clin Gastroenterol Hepatol 2011; 9 (12) 1098-1103
- 26 Sakorafas GH, Tsiotos GG, Sarr MG. Extrapancreatic necrotizing pancreatitis with viable pancreas: a previously under-appreciated entity. J Am Coll Surg 1999; 188 (06) 643-648
- 27 Foster BR, Jensen KK, Bakis G, Shaaban AM, Coakley FV. Revised Atlanta classification for acute pancreatitis: a pictorial essay. Radiographics 2016; 36 (03) 675-687
- 28 Sagar AJ, Khan M, Tapuria N. Evidence-based approach to the surgical management of acute pancreatitis. Surg J (NY) 2022; 8 (04) e322-e335
- 29 Sarathi Patra P, Das K, Bhattacharyya A. et al. Natural resolution or intervention for fluid collections in acute severe pancreatitis. Br J Surg 2014; 101 (13) 1721-1728
- 30 Baron TH, DiMaio CJ, Wang AY, Morgan KA. American Gastroenterological Association Clinical Practice Update: management of pancreatic necrosis. Gastroenterology 2020; 158 (01) 67-75.e1
- 31 Leppäniemi A, Tolonen M, Tarasconi A. et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg 2019; 14: 27
- 32 Lu JD, Cao F, Ding YX, Wu YD, Guo YL, Li F. Timing, distribution, and microbiology of infectious complications after necrotizing pancreatitis. World J Gastroenterol 2019; 25 (34) 5162-5173
- 33 De Waele JJ. Rational use of antimicrobials in patients with severe acute pancreatitis. Semin Respir Crit Care Med 2011; 32 (02) 174-180
- 34 Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 2013; 13 (4, Suppl 2): e1-e15
- 35 Muthusamy VR, Chandrasekhara V, Acosta RD. et al; ASGE Standards of Practice Committee. The role of endoscopy in the diagnosis and treatment of inflammatory pancreatic fluid collections. Gastrointest Endosc 2016; 83 (03) 481-488
- 36 Mowery NT, Bruns BR, MacNew HG. et al. Surgical management of pancreatic necrosis: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2017; 83 (02) 316-327
- 37 Takada T, Isaji S, Mayumi T. et al. JPN clinical practice guidelines 2021 with easy-to-understand explanations for the management of acute pancreatitis. J Hepatobiliary Pancreat Sci 2022; 29 (10) 1057-1083
- 38 van Santvoort HC, Bakker OJ, Bollen TL. et al; Dutch Pancreatitis Study Group. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology 2011; 141 (04) 1254-1263
- 39 Nakai Y, Shiomi H, Hamada T. et al; WONDERFUL Study Group in Japan. Early versus delayed interventions for necrotizing pancreatitis: a systematic review and meta-analysis. DEN Open 2022; 3 (01) e171
- 40 Manrai M, Dawra S, Singh AK, Jha DK, Kochhar R. Controversies in the management of acute pancreatitis: an update. World J Clin Cases 2023; 11 (12) 2582-2603
- 41 Werge M, Novovic S, Schmidt PN, Gluud LL. Infection increases mortality in necrotizing pancreatitis: a systematic review and meta-analysis. Pancreatology 2016; 16 (05) 698-707
- 42 Boxhoorn L, van Dijk SM, van Grinsven J. et al; Dutch Pancreatitis Study Group. Immediate versus postponed intervention for infected necrotizing pancreatitis. N Engl J Med 2021; 385 (15) 1372-1381
- 43 Qu C, Zhang H, Chen T. et al; Chinese Acute Pancreatitis Clinical Trials Group(CAPCTG). Early on-demand drainage versus standard management among acute necrotizing pancreatitis patients complicated by persistent organ failure: the protocol for an open-label multi-center randomized controlled trial. Pancreatology 2020; 20 (07) 1268-1274
- 44 Ke L, Dong X, Chen T. et al; Chinese Acute Pancreatitis Clinical Trials Group (CAPCTG). Early on-demand drainage or standard management for acute pancreatitis patients with acute necrotic collections and persistent organ failure: a pilot randomized controlled trial. J Hepatobiliary Pancreat Sci 2021; 28 (04) 387-396
- 45 Lu Z, Zhu X, Hua T. et al. Efficacy and safety of abdominal paracentesis drainage on patients with acute pancreatitis: a systematic review and meta-analysis. BMJ Open 2021; 11 (08) e045031
- 46 Freeman ML, Werner J, van Santvoort HC. et al; International Multidisciplinary Panel of Speakers and Moderators. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference. Pancreas 2012; 41 (08) 1176-1194
- 47 Gluck M, Ross A, Irani S. et al. Dual modality drainage for symptomatic walled-off pancreatic necrosis reduces length of hospitalization, radiological procedures, and number of endoscopies compared to standard percutaneous drainage. J Gastrointest Surg 2012; 16 (02) 248-256 , discussion 256–257
- 48 Ross AS, Irani S, Gan SI. et al. Dual-modality drainage of infected and symptomatic walled-off pancreatic necrosis: long-term clinical outcomes. Gastrointest Endosc 2014; 79 (06) 929-935
- 49 Gupta P, Koshi S, Samanta J. et al. Kissing catheter technique for percutaneous catheter drainage of necrotic pancreatic collections in acute pancreatitis. Exp Ther Med 2020; 20 (03) 2311-2316
- 50 Liu WH, Wang T, Yan HT. et al. Predictors of percutaneous catheter drainage (PCD) after abdominal paracentesis drainage (APD) in patients with moderately severe or severe acute pancreatitis along with fluid collections. PLoS One 2015; 10 (02) e0115348
- 51 Kohli P, Gupta V, Kochhar R, Yadav TD, Sinha SK, Lal A. Lavage through percutaneous catheter drains in severe acute pancreatitis: Does it help? A randomized control trial. Pancreatology 2019; 19 (07) 929-934
- 52 Werge M, Novovic S, Roug S. et al. Evaluation of local instillation of antibiotics in infected walled-off pancreatic necrosis. Pancreatology 2018; 18 (06) 642-646
- 53 Bhargava V, Gupta R, Vaswani P. et al. Streptokinase irrigation through a percutaneous catheter helps decrease the need for necrosectomy and reduces mortality in necrotizing pancreatitis as part of a step-up approach. Surgery 2021; 170 (05) 1532-1537
- 54 Bhargava MV, Rana SS, Gorsi U, Kang M, Gupta R. Assessing the efficacy and outcomes following irrigation with streptokinase versus hydrogen peroxide in necrotizing pancreatitis: a randomized pilot study. Dig Dis Sci 2022; 67 (08) 4146-4153
- 55 Mallick B, Tomer S, Arora SK. et al. Change in serum levels of inflammatory markers reflects response of percutaneous catheter drainage in symptomatic fluid collections in patients with acute pancreatitis. JGH Open 2019; 3 (04) 295-301
- 56 Hollemans RA, Bollen TL, van Brunschot S. et al; Dutch Pancreatitis Study Group. Predicting success of catheter drainage in infected necrotizing pancreatitis. Ann Surg 2016; 263 (04) 787-792
- 57 Sundaram Venkatesan G, Thulasiraman S, Kesavan B, Saravanan D, Chinnaraju N. Predicting the success of catheter drainage in infected necrotising pancreatitis: a cross-sectional observational study. Cureus 2022; 14 (12) e32289
- 58 Gouma DJ, van Geenen RC, van Gulik TM. et al. Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg 2000; 232 (06) 786-795
- 59 Knaebel HP, Diener MK, Wente MN, Büchler MW, Seiler CM. Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg 2005; 92 (05) 539-546
- 60 Vin Y, Sima CS, Getrajdman GI. et al. Management and outcomes of postpancreatectomy fistula, leak, and abscess: results of 908 patients resected at a single institution between 2000 and 2005. J Am Coll Surg 2008; 207 (04) 490-498
- 61 Bassi C, Marchegiani G, Dervenis C. et al; International Study Group on Pancreatic Surgery (ISGPS). The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 2017; 161 (03) 584-591
- 62 Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer Jr CM. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg 2013; 216 (01) 1-14
- 63 Martin AN, Narayanan S, Turrentine FE, Bauer TW, Adams RB, Zaydfudim VM. Pancreatic duct size and gland texture are associated with pancreatic fistula after pancreaticoduodenectomy but not after distal pancreatectomy. PLoS One 2018; 13 (09) e0203841
- 64 Iacono C, Verlato G, Ruzzenente A. et al. Systematic review of central pancreatectomy and meta-analysis of central versus distal pancreatectomy. Br J Surg 2013; 100 (07) 873-885
- 65 Cronin CG, Gervais DA, Castillo CF, Mueller PR, Arellano RS. Interventional radiology in the management of abdominal collections after distal pancreatectomy: a retrospective review. AJR Am J Roentgenol 2011; 197 (01) 241-246
- 66 Zink SI, Soloff EV, White RR. et al. Pancreaticoduodenectomy: frequency and outcome of post-operative imaging-guided percutaneous drainage. Abdom Imaging 2009; 34 (06) 767-771
- 67 Lee MJ, Wittich GR, Mueller PR. Percutaneous intervention in acute pancreatitis. Radiographics 1998; 18 (03) 711-724 , discussion 728
- 68 Wroński M, Cebulski W, Karkocha D. et al. Ultrasound-guided percutaneous drainage of infected pancreatic necrosis. Surg Endosc 2013; 27 (08) 2841-2848
- 69 Mosconi C, Cocozza MA, Piacentino F. et al. Interventional radiological management and prevention of complications after pancreatic surgery: drainage, embolization and islet auto-transplantation. J Clin Med 2022; 11 (20) 11
- 70 Bruennler T, Langgartner J, Lang S. et al. Outcome of patients with acute, necrotizing pancreatitis requiring drainage - Does drainage size matter?. World J Gastroenterol 2008; 14 (05) 725-730
- 71 Ke L, Li J, Hu P, Wang L, Chen H, Zhu Y. Percutaneous catheter drainage in infected pancreatitis necrosis: a systematic review. Indian J Surg 2016; 78 (03) 221-228
- 72 Gupta P, Bansal A, Samanta J. et al. Larger bore percutaneous catheter in necrotic pancreatic fluid collection is associated with better outcomes. Eur Radiol 2021; 31 (05) 3439-3446
- 73 Ganaie KH, Choh NA, Parry AH. et al. The effectiveness of image-guided percutaneous catheter drainage in the management of acute pancreatitis-associated pancreatic collections. Pol J Radiol 2021; 86: e359-e365
- 74 Khizar H, Zhicheng H, Chenyu L, Yanhua W, Jianfeng Y. Efficacy and safety of endoscopic drainage versus percutaneous drainage for pancreatic fluid collection; a systematic review and meta-analysis. Ann Med 2023; 55 (01) 2213898
- 75 Boxhoorn L, Voermans RP, Bouwense SA. et al. Acute pancreatitis. Lancet 2020; 396 (10252): 726-734
- 76 Vanek P, Trikudanathan G, Freeman ML. Diagnosing disconnected pancreatic duct syndrome: many disconnects, few answers. Dig Dis Sci 2021; 66 (05) 1380-1382
- 77 Maatman TK, Mahajan S, Roch AM. et al. Disconnected pancreatic duct syndrome predicts failure of percutaneous therapy in necrotizing pancreatitis. Pancreatology 2020; 20 (03) 362-368
- 78 Shrode CW, Macdonough P, Gaidhane M. et al. Multimodality endoscopic treatment of pancreatic duct disruption with stenting and pseudocyst drainage: how efficacious is it?. Dig Liver Dis 2013; 45 (02) 129-133
- 79 Rana SS, Sharma R, Kang M, Gupta R. Natural course of low output external pancreatic fistula in patients with disconnected pancreatic duct syndrome following acute necrotising pancreatitis. Pancreatology 2020; 20 (02) 177-181
- 80 Chong E, Ratnayake CB, Saikia S. et al. Endoscopic transmural drainage is associated with improved outcomes in disconnected pancreatic duct syndrome: a systematic review and meta-analysis. BMC Gastroenterol 2021; 21 (01) 87
- 81 Jagielski M, Smoczyński M, Adrych K. The role of endoscopic treatment of pancreatic duct disruption in patients with walled-off pancreatic necrosis. Surg Endosc 2018; 32 (12) 4939-4952
- 82 Wang ZJ, Song YH, Li SY. et al. Endoscopic management of pancreatic fluid collections with disconnected pancreatic duct syndrome. Endosc Ultrasound 2023; 12 (01) 29-37
- 83 Drake LM, Anis M, Lawrence C. Accuracy of magnetic resonance cholangiopancreatography in identifying pancreatic duct disruption. J Clin Gastroenterol 2012; 46 (08) 696-699
- 84 Bansal A, Gupta P, Singh AK. et al. Drainage of pancreatic fluid collections in acute pancreatitis: a comprehensive overview. World J Clin Cases 2022; 10 (20) 6769-6783
- 85 Kang M, Baloji A, Chowhan PS. Post-intervention complications and management: following percutaneous catheter drainage. Surg Open Sci 2023; 14: 5-8
- 86 Lorenz J, Thomas JL. Complications of percutaneous fluid drainage. Semin Intervent Radiol 2006; 23 (02) 194-204
- 87 Tsiotos GG, Smith CD, Sarr MG. Incidence and management of pancreatic and enteric fistulas after surgical management of severe necrotizing pancreatitis. Arch Surg 1995; 130 (01) 48-52
- 88 Gupta R, Kulkarni A, Babu R. et al. Complications of percutaneous drainage in step-up approach for management of pancreatic necrosis: experience of 10 years from a tertiary care center. J Gastrointest Surg 2020; 24 (03) 598-609
- 89 Barge JU, Lopera JE. Vascular complications of pancreatitis: role of interventional therapy. Korean J Radiol 2012; 13 (Suppl 1, Suppl 1): S45-S55