Tissue acquisition for diagnosis of biliary strictures using peroral cholangioscopy or endoscopic ultrasound-guided fine-needle aspiration
- Abstract
- BACKGROUND: Although endoscopic retrograde cholangiopancreatography (ERCP) is a first-line diagnostic modality for suspected malignant biliary stricture (MBS), the diagnostic yield of ERCP-based tissue sampling is insufficient. Peroral cholangioscopy-guided forceps biopsy (POC-FB) and endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) are evolving as reliable diagnostic procedures for inconclusive MBS. This study aimed to evaluate the usefulness of a diagnostic approach using POC-FB or EUS-FNAB according to the stricture location in patients with suspected MBS. METHODS: Consecutive patients diagnosed with suspected MBS with obstructive jaundice and/or cholangitis were enrolled prospectively. ERCP with transpapillary forceps biopsy (TPB) was performed initially. When malignancy was not confirmed by TPB, POC-FB using a SpyGlass direct visualization system or direct POC using an ultraslim endoscope was performed for proximal strictures, and EUS-FNAB was performed for distal strictures as a follow-up biopsy. RESULTS: Among a total of 181 patients, initial TPB showed malignancy in 122 patients, and the diagnostic accuracy of initial TPB was 71.8 % (95 % confidence interval [CI] 65.3 % - 78.4%]. Of the 59 patients in whom TPB was negative for malignancy, 32 had proximal biliary strictures and underwent successful POC. The remaining 27 patients had distal strictures and underwent successful EUS-FNAB. The accuracy of malignancy detection using POC-FB for proximal biliary strictures and EUS-FNAB for distal biliary strictures was 93.6 % (95 %CI 84.9 %-100 %) and 96.3 % (95 %CI 89.2 %-100%), respectively. The overall diagnostic accuracy for the combination of TPB with either POC-FB for proximal strictures and EUS-FNAB for distal strictures was 98.3 % (95%CI 95.9 %-100 %) and 98.4 % (95 %CI 95.3 %-100 %), respectively. CONCLUSIONS: An approach using POC-FB or EUS-FNAB according to the stricture location may be useful in the diagnosis of suspected MBS.
- All Author(s)
- Y. N. Lee
; J. H. Moon
; H. J. Choi
; H. K. Kim
; H. W. Lee
; T. H. Lee
; M. H. Choi
; S. W. Cha
; Y. D. Cho
; S. H. Park
- Issued Date
- 2019
- Type
- Article
- Keyword
- Aged; *Biliary Tract Neoplasms/complications/diagnosis/pathology; Cholestasis/diagnosis/etiology; Comparative Effectiveness Research; Constriction, Pathologic/diagnosis/etiology; *Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods; Endosonography/methods; Female; Humans; *Image-Guided Biopsy/instrumentation/methods; Jaundice, Obstructive/diagnosis/etiology; Male; Middle Aged; Specimen Handling/*methods; Surgical Instruments
- ISSN
- 0013-726x
- Citation Title
- Endoscopy
- Citation Volume
- 51
- Citation Number
- 1
- Citation Start Page
- 50
- Citation End Page
- 59
- Language(ISO)
- eng
- DOI
- 10.1055/a-0645-1395
- URI
- http://schca-ir.schmc.ac.kr/handle/2022.oak/2350
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