Percutaneous ultrasound-guided bowel wall core biopsy: a nonconventional way of diagnosis of gastrointestinal lesions

Patients with gastrointestinal lesions; unsuccessfully diagnosed by endoscopy are challenging to gastroenterologists. We aimed to study the role and safety of ultrasound, its guided biopsy in visualizing and diagnosing these bowel lesions.

Sixty-three patients with endoscopically and/or imaging documented gastrointestinal lesions were prospectively enrolled. All had detailed high-frequency (5–8 MHz) transabdominal bowel ultrasound examination to identify, localize and characterize the lesions, which were further biopsied using ultrasound guidance.

Lesions were histo-pathologically diagnosed; 57 (90.5 %) were malignant and 6 (9.5 %) were benign. Ultrasound was able to localize all the lesions. They were characterized as focal in 12 (19.1 %) and diffuse bowel wall involvement in 51 (80.9 %) patients. Ultrasound was capable of suggesting the nature of diffuse bowel involvement whether benign or malignant in 94.1 %. Comparing malignant diffuse bowel lesions and benign ones; the former had greater mean wall thickness (2.2 vs. 1.1 cm), loss of layering pattern (87.2 vs. 50 %), asymmetrical pattern of involvement (78.7 vs. 0 %), short length of affected segment (87.2 vs. 50 %) and paucity of perilesional findings. Ultrasound-guided core biopsy was diagnostic in 60 (95.2 %) patients with no reported complications. Diagnostic laparotomy was resorted to in 3 (4.8 %). Ultrasound-guided bowel wall core biopsy had sensitivity of 98.2 % in diagnosing malignant lesions and specificity of 66.6 % in benign lesions.

High-frequency transabdominal ultrasound and ultrasound-guided core biopsy of bowel lesions are potentially safe and effective diagnostic methods in select gastrointestinal lesions whenever conventional endoscopic diagnosis was unsuccessful, thus avoiding unnecessary diagnostic surgical procedures.