A biliary tract biopsy is a procedure that involves taking a sample of tissue or material from the duodenum, bile ducts, pancreas, or pancreatic duct. The sample is then tested for malignancy (cancer) or other diseases.

Tissue or material samples can be obtained in several ways, depending on the particular problem.

If there is a well-defined tumor, the sample can be taken through an aspiration needle. If the biopsy sample is taken through a needle, the puncture site will be numbed, and the needle inserted through the skin into the lining or tissue to be tested. A small amount of tissue is taken in through the needle, and the needle is removed. The puncture site is then covered to control any bleeding. Pressure may be applied to the puncture site if bleeding continues.

If there is an abnormality such as a stricture (narrowing) or blockage of the bile ducts or pancreatic ducts, a sample can be taken during procedures such as endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiogram (PTCA).

If the sample is taken during the ERCP, an endoscope is passed through the mouth into the duodenum. A catheter is inserted through the endoscope and into bile duct, and the sample is obtained. If a stricture or blockage is observed, the area will be brushed, and the sample of the brushed material will be analyzed.

If a PTCA is performed, the puncture site will be numbed, and the needle will be inserted through the skin into the ducts. A catheter will then be inserted to obtain a sample from the ducts.

Food and fluids are restricted 8-12 hours or more before the test. Your health care provider will give you specific instructions. You must sign an informed consent form.

Arrange transportation for yourself, because the procedure can induce weakness. Your medical history will be taken and the doctor will examine you to determine the problem.

For infants and children:

The preparation you can provide for this test depends on your child's age and experience. For specific information regarding how you can prepare your child, see the following:

• Infant test or procedure preparation (birth to 1 year)
• Toddler test or procedure preparation (1 to 3 years)
• Preschooler test or procedure preparation (3 to 6 years)
• School age test or procedure preparation (6 to 12 years)
• Adolescent test or procedure preparation (12 to 18 years)

If the biopsy is taken through a needle, there will be a slight stinging sensation when a local anesthetic (skin numbing medicine) is injected. Even after the anesthetic takes effect, there may be a cramping or pinching sensation during the procedure.

If the specimen is taken during an ERCP, you will receive a spray to help numb your throat. You also receive intravenous sedation and pain medications. As a result, there is generally minimal discomfort during the procedure.

A biopsy is necessary to distinguish between primary tumors and those that have metastasized (spread) from another location, and to determine if a growth is malignant.

A biopsy may also be taken:

• To test for diseases or infection
• After an X-ray, MRI, CT, or ultrasound has revealed abnormal growths

Tissue that is not cancerous, diseased, or infected is normal.

• Cholangiocarcinoma
• Liver cysts
• Malignant liver tumors (those that either started in the liver or spread to it)
• Pancreatic cancer
• Primary sclerosing cholangitis

There is some risk of bleeding from the biopsy site. With the needle biopsy, there is a slight chance of infection at the puncture site. Also see the risks for an ERCP if the biopsy is taken through an endoscope.

This test is performed after a health history, doctor's examination, or other tests and procedures have indicated abnormal growths, signs of malignancy, or signs of disease.