Dilation catheter-guided mini-forceps biopsy improves the diagnostic accuracy of malignant biliary strictures

Abstract Background Tissue sampling for biliary stricture is important for differential diagnosis and further treatment. The aim of this study was to assess a novel dilation catheter-guided mini-forceps biopsy (DCMB) method in the diagnosis of malignant biliary strictures. Methods 42 patients with malignant biliary stricture who underwent both brush cytology and DCMB during endoscopic retrograde cholangiopancreatography between October 2014 and November 2015 were retrospectively included. During DCMB, the mini biopsy forceps was introduced into the biliary stricture through the dilation catheter, and then the position and direction of the forceps were adjusted to obtain tissue samples. Results The positive rate of DCMB was significantly higher than that of brush cytology (81.0 % [34/42] vs. 38.1 % [16/42]; P < 0.001). No severe complications occurred; three patients (7.1 %) experienced mild procedure-related acute pancreatitis. Conclusions The novel DCMB technique was a practical, safe, efficient, and low-costing method for diagnosing malignant biliary stricture with a high accuracy rate.

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Endoductal Tissue Sampling of Biliary Strictures through Endoscopic Retrograde Cholangiopan Creatography (ERCP)

Tumori Journal ◽

10.1177/030089169708300314 ◽

1997 ◽

Vol 83 (3) ◽

pp. 698-702 ◽

Cited By ~ 7

Author(s):

Vittorio Pugliese ◽

Giovanna Antonelli ◽

Maura Vincenti ◽

Beatrice Gatteschi

Keyword(s):

Clinical Practice ◽

Bile Ducts ◽

Surgical Intervention ◽

Tissue Sampling ◽

Biliary Strictures ◽

Brush Cytology ◽

Endoscopic Retrograde ◽

Cytological Examination ◽

Forceps Biopsy ◽

A Value

Aim and background Pathological proof of malignant in biliary strictures is useful in the preoperative setting as it helps define therapeutic planning and prognosis, and reduces the length of the subsequent surgical intervention. However, it is difficult to obtain. The aim of this study was to evaluate the yield of histological and cytological examination of endobiliary samples obtained during endoscopic retrograde cholangiopancreatography (ERCP). Methods Endobiliary forceps biopsy and brush cytology were performed during ERCP examination in 52 consecutive patients, 36 with malignant and 16 with benign strictures. Results Histology and cytology turned out to have the same sensitivity (53%). The gain in sensitivity achieved by combining the two techniques was limited, reaching a value of 61%. The specificity, however, was 100% for both methods. Most of the few complications observed were due to sphincterotomy and subsided spontaneously or with medical treatment. However, one patient experienced a serious complication and chose to be treated by surgical intervention. The complication was caused by forceps biopsy. Conclusions This study shows that 1) sampling of biliary strictures during ERCP is the primary approach to tissue diagnosis; 2) brush cytology alone is sufficient in clinical practice; 3) forceps biopsy must always be used to sample intra-ampullary strictures but should be considered as a secondary step to sample strictures located more proximally, in the bile ducts, if previous cytology was negative.

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Endoscopic retrograde forceps biopsy and brush cytology of biliary strictures: a prospective study

Gastrointestinal Endoscopy ◽

10.1016/s0016-5107(95)70004-8 ◽

1995 ◽

Vol 42 (6) ◽

pp. 520-526 ◽

Cited By ~ 184

Author(s):

Vittorio Pugliese ◽

Massimo Conio ◽

Guido Nicolò ◽

Sebastiano Saccomanno ◽

Beatrice Gatteschi

Keyword(s):

Prospective Study ◽

Biliary Strictures ◽

Brush Cytology ◽

Endoscopic Retrograde ◽

Forceps Biopsy ◽

A Prospective Study

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Number of Endoscopic Retrograde Cholangiopancreatography Procedures Required for Short Biliary Cannulation Time

Gastroenterology Research and Practice ◽

10.1155/2017/1515260 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Koichiro Mandai ◽

Koji Uno ◽

Yasutoshi Fujii ◽

Takuji Kawamura ◽

Kenjiro Yasuda

Keyword(s):

Pancreatic Cancer ◽

Bile Duct ◽

Confidence Interval ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Odds Ratio ◽

Biliary Stricture ◽

Endoscopic Retrograde ◽

Biliary Cannulation ◽

Malignant Biliary Stricture ◽

Cannulation Success Rate

Background. Several previous studies assessed the competence in endoscopic retrograde cholangiopancreatography (ERCP) using the bile duct cannulation success rate. However, the cannulation time is also important, because a long cannulation time was reported to be a risk factor for post-ERCP pancreatitis. Aim. To determine the number of ERCP procedures required for short cannulation time of the bile duct. Methods. We retrospectively analyzed 605 ERCP procedures performed for bile duct cannulation in patients with native papilla at our institution between March 2012 and December 2015. The successful procedures were divided into 2 groups: group L and group S (cannulation time>15 minutes and ≤15 minutes, resp.). An analysis of the relationship among the biliary cannulation time, ERCP experience, and other factors was then conducted. Results. Multivariate analysis showed that the ERCP experience of ≤300 procedures (odds ratio, 2.080; 95% confidence interval, 1.337–3.142; P=0.001) and malignant biliary stricture due to pancreatic cancer (odds ratio, 1.912; 95% confidence interval, 1.072–3.412; P=0.028) were found to be significantly associated with a cannulation time of >15 minutes. Conclusions. Our findings suggested that an ERCP experience of ≤300 procedures and malignant biliary stricture due to pancreatic cancer were associated with prolonged biliary cannulation time.

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Combined brush cytology and stent placement in a single session for presumed malignant biliary stricture

Journal of Gastroenterology and Hepatology ◽

10.1111/j.1440-1746.2011.06725.x ◽

2011 ◽

Vol 26 (8) ◽

pp. 1247-1251 ◽

Cited By ~ 8

Author(s):

Natsuko Kawada ◽

Hiroyuki Uehara ◽

Kazuhiro Katayama ◽

Yasuna Takano ◽

Rena Takakura ◽

...

Keyword(s):

Stent Placement ◽

Biliary Stricture ◽

Single Session ◽

Brush Cytology ◽

Malignant Biliary Stricture

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Brush cytology guided by endoscopic retrograde cholangiopancreatography of biliary strictures

10.26226/morressier.59a6b342d462b80290b53ecc ◽

2017 ◽

Author(s):

Armando Peixoto

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Biliary Strictures ◽

Brush Cytology ◽

Endoscopic Retrograde

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Endobiliary jumbo forceps biopsy as a technique for diagnosing bile duct malignancies.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.197 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 197-197

Author(s):

Michael H. Hsu ◽

Rajeev Tummuru ◽

Abhitabh Patil

Keyword(s):

Bile Duct ◽

Surgical Resection ◽

Fine Needle Aspiration ◽

Biliary Stricture ◽

Needle Aspiration ◽

Biopsy Forceps ◽

Biliary Strictures ◽

Forceps Biopsy ◽

Fine Needle

197 Background: Pancreaticobiliary cancers are difficult to diagnose early and have a high associated mortality. Current methods of obtaining pathologic specimens from a biliary stricture include fine-needle aspiration, brush cytology, and endobiliary forceps biopsy. Among these forceps biopsy is the best, but is frequently limited by its low sensitivity (56%). The goal of this study is to evaluate the diagnostic yield and safety of jumbo forceps biopsies taken from the bile duct. Methods: All patients who presented to a single, tertiary academic referral center from July 2009 to July 2010 with a non-anastomotic biliary stricture were studied. This resulted in 9 patients with common bile duct strictures – 3 male and 6 female (ages 29-83, mean 61). All subjects underwent ERCP by the same gastroenterologist with endobiliary jumbo forceps biopsy using the Boston Scientific Radial Jaw 4 jumbo biopsy forceps. Specimens obtained were compared to available specimens obtained via fine needle aspiration, cytologic brushing or surgical resection. Patients with benign results were followed clinically for 1 year. Results: Three patients had benign biliary strictures as determined by clinical follow-up or surgical resection specimen. Jumbo forceps biopsy diagnosed a benign entity in 100% of these cases. Among the remaining 6 patients with malignant strictures, jumbo biopsy diagnosed a malignancy in 83% of cases. Tissue obtained was deemed adequate for histologic evaluation in 8 of 9 patients. The exception was recognized at the time of the procedure and was attributed to the technical inability to adequately open the biopsy forceps within the bile duct. Of the technically successful cases, 100% yielded an accurate histologic diagnosis as determined by concordant alternative sampling or clinical follow-up. In the 90 days following jumbo forceps biopsy, there were no adverse events such as bleeding, cholangitis, pancreatitis, perforation, peritonitis, or need for hospitalization. Conclusions: In our limited study, the use of jumbo forceps biopsies is safe and, when technically feasible, has a very high yield in evaluating biliary strictures. Larger studies are needed to confirm our findings.

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