Original size Ø 1,1 mm Highly flexible Memory effect Experience with the MTW Puncture Biopsy Forceps – Case series Geke Litjens1, MD and Erwin-Jan, M van Geenen2, PharmD, MD, PhD | Radboud University Medical Center, Department of Radiology and Nuclear Medicine1 | Department of Gastroenterology and Hepatology Nijmegen2 Between July 1st and October 31st 2018 EUS-guided biopsy, of the pancreas, with the 19-gauge Puncture Biopsy Forceps (PBF) of MTW Endoskopie Manufaktur, Wesel, Germany was performed at the Radboudumc on 4 patients. In all patients fine needle aspiration (FNA) was also performed with a conventional 22-gauge needle (...), with on-site pathology present. All EUS procedures were performed by the same gastroenterologist (EvG). All patients where male and the age ranged from 57 to 71 years. Patient 1, 3 and 4 were planned for an EUS-guided biopsy because they were suspected to have pancreatitis but a malignant tumor was also in the differential diagno- sis. Patient 2 was suspected to have a locally advanced pancreatic adenocarcinoma for which pathological con- firmation was desired before starting systemic therapy. No adverse events occurred. In 2015 we tested a previous version of the PBF [1] after which the needle design is updated. The new needle is still very sharp which results in easy penetration of the gastric or duodenal wall and the pancreatic tissue. The forceps mechanism in the tip continues to work well even after multiple biopsies in the same patient. The tip of the new needle is made of Nitinol which facilitates better bridging possibilities which results into better aiming of the needle. Although the tip is now flexible, working in a position in which the endoscope is strongly curved is still challenging due to the thickness of the needle (19-gauge). The EUS-opacity of the new needle was decreased, compared to the previous version of the needle (Figure 2). Therefore, EUS-needle was adjusted and tested on a piece of beef, which resulted in an improved (very good) EUS visibility. This newest version was not used on pa- tients in our centre yet. The handle of the needle was also updated since the first version. There is a lock mechanism to prevent the needle from opening while it is being introduced. This is a useful update to improve safety, however in patient 2 the needle was still accidently opened in the shaft by the nurse that assisted the procedure. 1.Litjens, G., et al., First experience of obtaining pancreatic tissue with a puncture biopsy forceps versus fine needle aspiration. Endoscopy, 2015. 47 Suppl 1: p. E609-10. 18