Endoscopic Evaluation of Biliary Strictures: Current and Emerging Techniques

Abstract

The diagnosis of biliary strictures in clinical practice can be challenging. Discriminating between benign and malignant biliary strictures is important to prevent the morbidity and mortality associated with incorrect diagnoses. Missing a malignant biliary stricture may delay surgery, resulting in poor prognostic outcomes. Conversely, it has been demonstrated that approximately 20% of patients who undergo surgery for suspected biliary malignancies have a benign etiology on histopathology. Traditional tissue sampling using endoscopic retrograde cholangiography does not always produce a definitive diagnosis, with a considerable proportion of cases remaining as indeterminate biliary strictures. Recent advances in endoscopic techniques have the potential to improve the diagnostic and prognostic accuracy of biliary strictures. Clin Endosc 2021 May 27. [Epub ahead of print]

Case report: The diagnostic dilemma of indeterminate biliary strictures: report on two cases with a literature review

“…Improvement of sampling techniques, such as combined bile aspiration, cytobrush and biopsy, balloon dilatation before sampling, modified biopsy forceps, wire grasping technique of biopsy, and rapid on-site evaluation (ROSE), have been proved to increase ERCP sensitivity of MBSs. On the whole, all these modifications in the ERCP sampling techniques appear not to reach a satisfactory extent in the diagnostic accuracy in IBSs ( 17 ). Nevertheless, technical familiarity, universal availability, perfect specificity, and relief of obstructive jaundice synchronously have contributed to kept these ERCP-based techniques in business over the past decade.…”

Nightmare of straight-type plastic stent migration into the peripheral bile duct: what is my savior?

“…Biliary plastic stent placement via ERCP is widely used to treat obstructive jaundice due to malignant stricture. 1 The incidence of proximal migration of biliary plastic stents has been reported to be 3.1% to 4.9%, [2][3][4][5] and the success rate of stent retrieval was approximately 88% in the first attempt. 5,6 Traditionally, stone extraction balloon catheters, stone retrieval baskets, forceps, and Soehendra stent retrievers have been used to retrieve proximally migrated stents.…”

Biliary Tree Diagnostics: Advances in Endoscopic Imaging and Tissue Sampling

“…Optical coherence tomography (OCT) is a real-time optical imaging technique, similar to ultrasonography, except for the use of infrared light instead of high-frequency sound waves. Light is reflected or scattered from tissues to generate a cross-sectional tomographic image of the target area [97,98]. OCT provides greater spatial resolution than IDUS and allows to evaluate larger surfaces areas compared to CLE, that also requires contrast medium injection.…”