P3725 - EUS-Guided Transgastric Kidney Biopsy: A Novel Approach

Award: Presidential Poster Award

Andy Lin, MD¹, David L. Cheung, MD², Amirali Tavangar, MD¹, Tina Zhou, BS¹, Samuel Ji, MD¹, Khaldoon Khirfan, MD¹, Jason Samarasena, MD¹, John Lee, MD^1
1University of California Irvine, Orange, CA; ²UC Irvine, Orange, CA

Introduction: Incidentalomas have increased as computed tomography has become a highly utilized pillar in the medical care setting.1 Renal masses are no exception, with the standard of diagnosis being biopsy. Percutaneous approach is the mainstay of renal mass biopsy, however, may be technically difficult in setting of obesity or anatomically distant lesion from the skin.2 We present a case of endoscopic ultrasound guided transgastric kidney biopsy with adequate yield.

Case Description/Methods: A 73-year-old man suffered from right nephrolithiasis with discovery of an incidental left upper pole renal cortical neoplasm on CT scan. After urologic evaluation, the mass was deemed to have difficult access using a percutaneous approach and was referred to interventional gastroenterology for a transgastric biopsy. Using endoscopic ultrasound, a poorly defined left renal hypoechoic lesion measuring 34x27 mm was visualized. (Figure 1) Two core biopsies were taken using a 19g needle. Tissue aggregate measured 1.2x0.4x0.2 cm and was considered an adequate specimen by our pathologists with the final diagnosis being Type 1 papillary renal cell carcinoma. The postprocedural course was uneventful.

Discussion: Percutaneous biopsy of renal masses has long been the gold standard approach. in cases of difficult percutaneous approach due to body habitus, endoscopic ultrasound guided transgastric for left-sided renal and transduodenal for right-sided renal lesions potentially provide a valuable, safe and minimally invasive alternative.

References:
1. Berland LL, Silverman SG, Gore RM, Mayo-Smith WW, Megibow AJ, Yee J, Brink JA, Baker ME, Federle MP, Foley WD, Francis IR. Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. Journal of the American College of Radiology. 2010 Oct 1;7(10):754-73.
2. Kwong J, May G, Ordon M. Endoscopic ultrasound-guided trans-duodenal fine-needle biopsy of a small renal mass: case report and review of the literature. African Journal of Urology. 2021 Dec;27:1-4.



Disclosures:


Andy Lin, MD¹, David L. Cheung, MD², Amirali Tavangar, MD¹, Tina Zhou, BS¹, Samuel Ji, MD¹, Khaldoon Khirfan, MD¹, Jason Samarasena, MD¹, John Lee, MD¹. P3725 - EUS-Guided Transgastric Kidney Biopsy: A Novel Approach, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.