AN ARGUMENT AGAINST ROUTINE PERCUTANEOUS BIOPSY, ERCP, OR BILIARY STENT PLACEMENT IN PATIENTS WITH CLINICALLY RESECTABLE PERIAMPULLARY MASSES - A SURGICAL PERSPECTIVE

Improved resolution of computed tomography (CT) and ultrasonography al lows us to visualize the proximal extent of biliary obstruction and th e presence of a periampullary mass in most patients with malignant ext rahepatic biliary obstruction. Our purpose in this report is to challe nge the need for preoperative percutaneous biopsy, endoscopic retrogra de cholangiopancreatography, or preoperative placement of a biliary en doprosthesis in the good-risk patient in whom the imaging procedure cl early defines a periampullary mass and the proximal extent (hepatic ex tent) of biliary obstruction. We recently managed three patients in wh om one of these invasive procedures led to a complication that delayed , prevented, or complicated appropriate operative resection of a pancr eatic neoplasm. Because a negative percutaneous biopsy, cholangiograph ic imaging of a dilated bile/pancreatic duct clearly seen on CT or ult rasonography, or short-term preoperative biliary decompression does no t alter the decision for operative exploration and may cause complicat ions, we argue against their use in the good-risk patient with both ex trahepatic biliary obstruction and a periampullary pancreatic mass wel l delineated on noninvasive imaging.