Improved Accuracy of Percutaneous Biopsy Using “Cross and Push” Technique for Patients Suspected with Malignant Biliary Strictures



Various methods have been used to sample biliary strictures, including percutaneous fine-needle aspiration biopsy, intraluminal biliary washings, and cytological analysis of drained bile. However, none of these methods has proven to be particularly sensitive in the diagnosis of biliary tract malignancy. We report improved diagnostic accuracy using a modified technique for percutaneous transluminal biopsy in patients with this disease.

Materials and Methods

Fifty-two patients with obstructive jaundice due to a biliary stricture underwent transluminal forceps biopsy with a modified “cross and push” technique with the use of a flexible biopsy forceps kit commonly used for cardiac biopsies. The modification entailed crossing the stricture with a 0.038-in. wire leading all the way down into the duodenum. A standard or long sheath was subsequently advanced up to the stricture over the wire. A Cook 5.2-Fr biopsy forceps was introduced alongside the wire and the cup was opened upon exiting the sheath. With the biopsy forceps open, within the stricture the sheath was used to push and advance the biopsy cup into the stricture before the cup was closed and the sample obtained. The data were analysed retrospectively.


We report the outcomes of this modified technique used on 52 consecutive patients with obstructive jaundice secondary to a biliary stricture. The sensitivity and accuracy were 93.3 and 94.2 %, respectively. There was one procedure-related late complication.


We propose that the modified “cross and push” technique is a feasible, safe, and more accurate option over the standard technique for sampling strictures of the biliary tree.

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We acknowledge Felicity Evison, Statistical Intelligence Unit, University Hospital Birmingham. For assistance in data evaluation.

Conflict of Interest

Kamarjit Mangat: recieved professional fees from Cook Medical, to present the study findings at the CIRSE 2012 and SIR 2013 meetings. Cook Medical has patented a Transluminal Biliary Biopsy Forceps Set (BBFS-100) with royalties paid to Kamarjit Mangat. Prashant Patel and Balaji Rangarajan have no conflicts of interest to disclose.

Statement of Human and Animal Rights and Informed Consent

The reported study is a technical note and did not require ethics committee approval. The study was logged as an Institutional audit. Informed consent was obtained from all individual participants included in the study.

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Correspondence to Kamarjit Mangat.

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Patel, P., Rangarajan, B. & Mangat, K. Improved Accuracy of Percutaneous Biopsy Using “Cross and Push” Technique for Patients Suspected with Malignant Biliary Strictures. Cardiovasc Intervent Radiol 38, 1005–1010 (2015).

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  • Non-vascular interventions
  • Biopsy
  • Bile duct/gallbladder/biliary
  • Cancer
  • Diagnostic