Transportal endovascular biopsy prior to portal vein stenting in pancreatic cancer

Introduction Biopsy is required for pancreatic cancer prior to chemotherapy. In some patients, biopsy is not feasible, because there is no safe window for either percutaneous or endoscopic ultrasound (EUS)-guided biopsy. Case report In a 72-year-old male patient with obstruction of the portomesenteric venous confluence due to a tumour of the pancreatic head, repeat EUS-guided biopsy attempts of the tumour remained inconclusive. The patient underwent transjugular portosystemic shunt with portal vein recanalization (PVR-TIPS) followed by transportal endovascular biopsy using a gastroscope biopsy forceps, confirming pancreatic ductal adenocarcinoma. Interventional treatment was completed by transjugular portal vein stenting for the management of ascites and bowel oedema. Conclusion Endovascular transportal biopsy is a feasible method for obtaining a histopathological diagnosis in pancreatic head tumours, even after failed EUS-guided biopsy.