Fluoroscopy-Guided Percutaneous Endobiliary Forceps Biopsy for Tissue Diagnosis in Complex Biliary Obstruction: A Consecutive Single-Center Study

Objective: This study evaluated fluoroscopy-guided percutaneous endobiliary forceps biopsy (PEFB) for tissue diagnosis in complex biliary obstruction when no safe extraluminal biopsy target was available or when prior conventional tissue acquisition had been non-diagnostic.Methods: This retrospective single-center study included consecutive patients who underwent PEFB between January 2024 and December 2025.PEFB was considered after multidisciplinary evaluation, when tissue diagnosis was required and conventional image-guided or endoscopic tissue acquisition was unavailable, unsuitable, or non-diagnostic.Procedures were performed under fluoroscopic guidance using an 8 French introducer sheath and disposable biopsy forceps.Outcomes included technical success, clinically interpretable tissue acquisition, final diagnosis, biopsy-guided management, and adverse events.Results: Thirteen patients were included (median age 62 years; 9 women).A safe extraluminal biopsy target was absent in 12 patients; the remaining patient underwent rescue PEFB after two non-diagnostic core biopsies of a desmoplastic pancreatic/peribiliary mass.Five patients had prior endoscopic retrograde cholangiopancreatography-based evaluation, plastic stent placement, or non-definitive endoscopic sampling.PEFB was performed in 13 sessions, with 49 biopsy bites across 16 access-site sampling locations.Technical success and clinically interpretable tissue acquisition were achieved in all patients.Final diagnoses were malignant in eight patients, benign/inflammatory in four, and an intraductal papillary neoplastic lesion in one.PEFB findings guided subsequent management in all patients.No biopsy-related major adverse event occurred.Conclusion: Fluoroscopy-guided PEFB may provide clinically actionable tissue in selected patients with complex biliary obstruction when conventional image-guided or endoscopic tissue acquisition is unavailable, unsuitable, or non-diagnostic.