Endoscopic transpapillary biopsies and intraductal ultrasonography in the diagnostics of bile duct strictures: a prospective study

Abstract

Background: In bile duct strictures, examination of wall layers by intraductal ultrasonography (IDUS) performed during endoscopic retrograde cholangiopancreatography (ERCP) may be diagnostically useful. Methods: In the present study 60 patients with bile duct strictures of unknown aetiology were examined preoperatively by ERCP, including transpapillary biopsies and IDUS. Histopathological correlation was available for all patients undergoing these procedures. Results: Postoperative diagnosis revealed 30 pancreatic carcinomas, 17 bile duct cancers, three gall bladder cancers, and 10 benign bile duct strictures. Using endoscopic transpapillary forceps biopsies (ETP), a correct preoperative diagnosis was achieved in 36 of 60 patients (60% of cases). Among the 50 malignant tumours, preoperative diagnosis by ETP revealed a sensitivity of 52% and a specificity of 100%. ERCP supplemented by IDUS allowed for correct preoperative diagnosis in 83% of cases (50 of 60 patients), which was significantly higher than the accuracy of ETP (p=0.008). By combining ETP with IDUS, a correct preoperative diagnosis was made in 59 of 60 patients resulting in an accuracy rate of 98%. Conclusions: Because of its low accuracy, exclusive use of ETP is not a reliable diagnostic tool for a definitive preoperative diagnosis of bile duct strictures. By combining IDUS and ETP with ERCP however, preoperative diagnostic accuracy can be improved substantially.

A Case of Adenomyomatous Hyperplasia of the Distal Common Bile Duct Mimicking Malignant Stricture

“…Cholangioscopy allows a direct visualization and targeted biopsies with sensitivity of 60.1%, 17 and the sensitivity of intraductal ultrasound is about 88%. 18,19 However, distal bile duct evaluation is limited. Endoscopic ultrasound with fine needle aspiration can be performed for distal extrahepatic bile duct strictures, as the reported sensitivity and negative likelihood ratio for diagnosis of malignancy were 66% and 0.34, respectively.…”

Surgical strategy for bile duct cancer: Advances and current limitations

“…On the other hand, ERC and PTBD have the advantage of enabling IDUS or choledochoscopy and of providing bile cytology, brushing cytology, and biopsy, which can confirm the diagnosis of cholangiocarcinoma [78] . Unfortunately, these histopathologic examinations yield low sensitivity, and non-diagnostic cytology or biopsy results may not rule out cholangiocarcinoma in the presence of appropriate radiologic findings [79,80] . In the absence of other explainable causes of biliary strictures, patients should be assumed to have cancer and operated on as such, accepting that 10% to 15% might prove to have a benign lesion on the final histologic investigation [81,82] .…”

Stellenwert der endoskopischen retrograden Cholangiopankreatographie, der perkutan-transhepatischen Cholangiographie, der Endosonographie und der endoluminalen Sonographie in der Behandlung des Gallenblasen- und des Gallengangkarzinoms

“…Bei weit fortgeschrittenem Tumor oder einer Komorbidität der zumeist älte-ren Patienten, die eine Operation nicht zulässt, liegt die Bedeutung der ERC in der Möglichkeit des palliativen Gallengang-Stenting. Sind die Gallenwege endoskopisch nicht er-ter Stellenwert zu, da die vorgeschaltete Bildgebung mittels Sonographie, Computertomographie und zunehmend Magnetresonanztomographie (MRT) inklusive Magnetresonanzcholangiopankreatikographie (MRCP) dies bereits aufzeigen kann [15]. Der Versuch einer direkten Tumordarstellung eines Gallenblasenkarzinoms, das nicht in die unmittelbare Nähe des Gallengangs infiltrierend wächst, ist durch die geringe Eindringtiefe der Minisonde (zirka 20 mm) limitiert [16].…”