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 cancer or other diseases.

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

If there is a well-defined tumor, the sample can be taken through an aspiration needle. The puncture site will be numbed. Then the needle is 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 a problem such as a narrowing (stricture) or blockage of the bile ducts or pancreatic ducts, a sample can be taken during procedures such as:

• Endoscopic retrograde cholangiopancreatography (ERCP)
• 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 the bile duct, and the sample is obtained. If a narrowing or blockage is observed, the area will be brushed. Then the sample of the brushed material will be analyzed.

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

You may not be able to eat or drink 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 cause weakness. The health care provider will take your medical history and 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, you will feel a slight stinging sensation when the skin numbing medicine (local anesthetic) is injected. Even after the anesthetic takes effect, you may feel 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 will also receive sedation and pain medications through a vein (IV). As a result, you should not feel much discomfort during the procedure.

A biopsy can determine whether a tumor started in the liver or spread from another location. It also can determine if a growth is cancerous.

A biopsy may also be taken:

• After a doctor's examination, x-ray, MRI, CT scan, or ultrasound has revealed abnormal growths
• To test for diseases or infection

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

• Cancerous liver tumors (those that either started in the liver or spread to it)
• Cholangiocarcinoma
• Liver cysts
• 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.