A New Method of Biliary Sampling for Cytopathological Examination During Endoscopic Retrograde Cholangiography

Abstract

Significantly higher cellular and diagnostic yields can be obtained at ERC in patients with suspected malignant biliary stricture by combining stricture dilation and a grasping basket compared with brushing.

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

“…Brush cytology during endoscopic retrograde cholangiopancreatography (ERCP) is a simple and common technique for establishing the diagnosis of biliary stricture; however, its sensitivity has been reported to be low, ranging from 35% to 72% 1–7 . Alternative techniques, such as stricture dilation followed by collecting materials using grasping basket or a combination of several techniques including brush cytology, have been reported with improved sensitivity 8–11 . However, these procedures are more complicated and traumatic.…”

Novel endoscopic approaches for assessing biliary tract diseases

“…Samples taken by basket had a significantly higher sensitivity compared with the routine brush group (80% versus 48%) [6]. In a second study, the same group [7] compared cellular and diagnostic yields of samples obtained during ERCP using either combined stricture dilation and a grasping basket with that obtained using a standard biliary cytology brush. Sixty patients with suspected malignant bile duct obstruction were sampled with one of the two techniques.…”

“…The combined stricture dilation and grasping basket technique provided significantly higher cellular yield, a significantly higher sensitivity for malignancy detection (86% versus 52%), and a significantly higher diagnostic accuracy (90% versus 67%) compared with samples obtained by brushing. The 30-day complication rate for the multimodality technique was only 3% [7]. Given these results, stricture dilation and the use of a grasping basket is superior to standard brush cytology in achieving diagnostic results for malignant strictures.…”

Brushing Cytology of the Biliary Tract: Bile Juice from the ERCP Sheath Tube Provides Cell-Rich Smear Samples

“…To improve the sensitivity and specificity, many investigators employ various sampling techniques, new devices, the cell block method and molecular methods, such as k-ras point mutation analysis or FISH [7,8,9,10,11,12,13,14,15,16,17,18,19,20]. In some hospitals, to facilitate smear sampling, rapid on-site evaluation is used to prevent air-drying and insufficient sampling [20].…”