Diagnostic yield and safety of ultrasound-guided bowel mass biopsies in children

Derek J Roebuck,Neil Sebire,Kishore Minhas,Premal A Patel,Alex Barnacle,Paolo De Coppi

doi:10.1007/s00247-019-04472-8

Abstract

BackgroundTraditionally, ultrasound (US)-guided bowel mass biopsies are avoided in favour of endoscopic or surgical biopsies. However, endoscopy cannot easily reach lesions between the duodenojejunal flexure and the terminal ileum and lesions not involving the mucosa may not be accessible via an endoscopic route.ObjectiveThe aim of this study was to report our technique and to assess the diagnostic accuracy and safety of US-guided biopsy of bowel masses in children.Materials and methodsWe conducted a 14-year retrospective review of US-guided bowel mass biopsies at a single paediatric hospital.ResultsTwenty US-guided bowel mass biopsies were performed in 19 patients (median age: 6 years and 6 months, range: 22 months–17 years, median weight: 22 kg, range: 10.2–48.4 kg). For 14 biopsies, there was no other lesion that could potentially be biopsied. A percutaneous coaxial technique was used for 19 biopsies and a transanal non-coaxial biopsy was performed in 1. A median of 9 (range: 2–15) cores of tissue was obtained at each biopsy. The technical success rate and adequacy of diagnostic yield were 100%. The most common diagnosis was lymphoma, which occurred in 16 biopsies. Three biopsies contained mucosa. There was one complication out of 20 biopsies (5%, 95% confidence interval 0–15%): a self-limiting, post biopsy pyrexia. Nineteen procedures were accompanied by a bone marrow aspirate and/or trephine within 2 weeks of the bowel biopsy, only one of which was diagnostic.ConclusionUS-guided bowel mass biopsy can be performed safely in children, with a high diagnostic yield and low complication rate.

Highlights

IntroductionThe main limitation of performing an endoscopic biopsy of a bowel mass is that the reach of the endoscope is limited to the portions of the gastrointestinal tract between the mouth and the duodenojejunal flexure and between the rectum and the terminal ileum
Biopsies of masses arising from the bowel in children are performed endoscopically or surgically, via a laparotomy or laparoscopic approach.The main limitation of performing an endoscopic biopsy of a bowel mass is that the reach of the endoscope is limited to the portions of the gastrointestinal tract between the mouth and the duodenojejunal flexure and between the rectum and the terminal ileum
Technical success was defined as acquiring tissue from the bowel mass using a US-guided biopsy technique

Summary

Introduction

The main limitation of performing an endoscopic biopsy of a bowel mass is that the reach of the endoscope is limited to the portions of the gastrointestinal tract between the mouth and the duodenojejunal flexure and between the rectum and the terminal ileum. A bowel mass anywhere from the duodenojejunal flexure to the terminal ileum will be beyond the reach of an endoscopic biopsy. Endoscopic biopsies are largely limited to the mucosa and submucosa and so intramural, subserosal or exophytic lesions may not be adequately sampled [1]. In such cases, endoscopic ultrasound (US)guided biopsies may be considered. Endoscopy cannot reach lesions between the duodenojejunal flexure and the terminal ileum and lesions not involving the mucosa may not be accessible via an endoscopic route

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Discussion

Conclusion