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

BACKGROUND: 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. PATIENTS AND METHODS: 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.
RESULTS: 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.
CONCLUSION: 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.