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with a puncture biopsy forceps versus fine needle aspiration A 36-year-old woman presented with abdominal pain, steatorrhea, and weight loss of 8kg. A computed tomography (CT) scan showed an enlarged pancreas with the characteristics of autoimmune pancreatitis (AIP). Because of the suspicion of an autoimmune pancreatitis, she was scheduled for endoscopic ultrasound (EUS) with a 19-gauge puncture biopsy forceps (PBF; MTW Endoskopie Manufaktur, Wesel, Germany) (●" Fig.1) and conventional 22-gauge fine needle aspiration (FNA) needle (Cooke). The EUS revealed no signs of chronic pancreatitis and her pancreatic duct was normal. We performed two passes with the FNA needle and took three biopsies with the new PBF, in both cases sampling the pancreatic body, which was reached through the gastric wall at the greater curvature of the body. No adverse events occurred. The PBF was very sharp, which resulted in easy penetration of the gastric wall and pancreatic body. Additionally the entire needle and its opening were clearly visible on the ultrasound imaging (●" Fig.2), allowing good precision of the biopsy location. The PBF histology consisted of four small pieces of tissue up to 1mm. The cut material showed acinar pancreatic tissue without any specific abnormalities (●" Fig.3). The differences in terms of pathology between the PBF and FNAwere: (i) histology versus cytology, meaning that the material from the PBF could be assessed for tissue coherence and architecture; (ii) material obtained with the PBF contained less contamination with blood and gastric mucosa, which promoted easier Fig.1 The puncture biopsy forceps (PBF): a in closed position; b in opened position; c device handle.

First experience of obtaining pancreatic tissue with a puncture biopsy forceps versus fine needle aspiration