Ropeway-type bile duct biopsy forceps with a side slit for a guidewire

Background: Transpapillary procurement of bile duct biopsy specimens is an effective diagnostic technique in cases of biliary structure. The utility o f new ropeway-type bile duct biopsy forceps with a side slit for a guidewir e was investigated in this study. Methods: The 12 patients in this study had bile duct cancer (n = 3), cancer of the head of the pancreas (n = 4), gallbladder cancer (n = 1), and benig n bile duct stenosis (n = 4). After endoscopic retrograde cholangiography, a guidewire was placed in the bile duct across the stenosis. The new forcep s (1.8-mm diameter clamshell-type biopsy forceps without needle) was then i ntroduced through the intact papilla along the guidewire. Results: In all patients, sufficient tissue for histopathologic evaluation was obtained without complication. In one patient, biopsy specimens were se lectively obtained of the left hepatic duct, which was Impossible with conv entional forceps. In another patient, histologic examination of specimens o btained by using this new forceps showed adenocarcinoma, whereas specimens obtained with a conventional forceps did not contain adenocarcinoma. Howeve r, In another patient, biopsy specimens obtained with a conventional forcep s contained adenocarcinoma that was not evident in specimens obtained with the new forceps, Dislodgement of the guidewire during procurement of biopsy specimens occurred in 1 patient. In the other 11 patients, an endoscopic b iliary drain was inserted over the guidewire. Conclusion: The new ropeway-type biopsy forceps is useful for selectively o btaining biopsy specimens of the bile duct. With this system, access for su bsequent endoscopic biliary drainage is maintained.