Percutaneous image-guided biopsies of pancreatic malignancies may prove challenging and nondiagnostic due to a variety of anatomic considerations. For patients with complex post-surgical anatomy, such as a Roux-en-Y gastric bypass, diagnosis via endoscopic ultrasound with fine-needle aspiration may not be possible because of an inability to reach the proximal duodenum. This report describes the first diagnostic case of transbiliary intravascular ultrasound-guided biopsy of a pancreatic head mass in a patient with prior Roux-en-Y gastric bypass for which a diagnosis could not be achieved via percutaneous and endoscopic approaches. Transbiliary intravascular ultrasound-guided biopsy resulted in a diagnosis of pancreatic adenocarcinoma, allowing the initiation of chemotherapy.
Chick, J. F. B., Roush, B. B., Khaja, M. S., Prohaska, D., Cooper, K. J., Saad, W. E., & Srinivasa, R. N. (2017). Transbiliary intravascular ultrasound-guided diagnostic biopsy of an inaccessible pancreatic head mass. Radiology Case Reports, 12(2), 323–326. https://doi.org/10.1016/j.radcr.2017.01.002