Complications and management strategies in ultrasound-guided omental biopsies: A clinical cohort study of on-table interventions and outcomes in a Tertiary Care Hospital.

Abstract

Objective: To evaluate the frequency and nature of complications associated with ultrasound-guided omental biopsies and to assess the effectiveness of immediate on-table management strategies using a co-axial biopsy technique. Study Design: Prospective Observational Clinical Cohort study. Setting: Department of Interventional Radiology, Tertiary Care Hospital, Lady Reading Hospital, Peshawar.  Period: June 2025 to June 2026. Methods: Included 115 consecutive patients undergoing ultrasound-guided omental biopsy using a co-axial core biopsy system. Demographic data, lesion characteristics, procedural details, complication rates, bleeding severity, and management strategies were recorded prospectively. Minor bleeding was managed using autologous clotted blood injection through the same c o-axial tract, whereas major bleeding was treated using Gel Foam slurry embolization followed by manual compression. Post-procedural ultrasound follow-up was performed to assess residual hematoma formation and delayed complications. Results: Among the 115 patients included in the study, 81 (70.4%) were female and 34 (29.6%) were male. Bleeding complications occurred in 12 patients (10.4%). Minor bleeding occurred in 9 patients (7.8%) and was successfully managed with autologous clot injection through the existing co-axial needle tract. Major bleeding occurred in 3 patients (2.6%) and was managed successfully using Gel Foam slurry embolization through the same tract followed by manual compression for 15 minutes. Technical success of hemostasis was achieved in 100% of complicated cases. No patient required surgical intervention, angiographic embolization, blood transfusion, or intensive care admission. Follow-up ultrasound demonstrated no residual hematoma or delayed bleeding complications. Conclusion: Ultrasound-guided omental biopsy using the co-axial technique is a safe, effective, and minimally invasive diagnostic procedure. Immediate management of bleeding complications through the same access tract significantly enhances procedural safety, minimizes patient morbidity, reduces resource utilization, and eliminates the need for additional invasive interventions.