Endoscopic Ultrasound-Guided Fine Needle Aspiration and Endoscopic Retrograde Cholangiopancreatography-Based Tissue Sampling in Suspected Malignant Biliary Strictures: A Meta-Analysis of Same-Session Procedures

Abstract

Background/Aims: The diagnosis of biliary strictures can be challenging. There are no systematic reviews studying same-session endoscopic retrograde cholangiopancreatography (ERCP)-based tissue sampling and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for the diagnosis of biliary strictures. Methods: A systematic review was conducted on studies analyzing same-session EUS and ERCP for tissue diagnosis of suspected malignant biliary strictures. The primary outcome was the accuracy of each method individually compared to the two methods combined. The secondary outcome was the accuracy of each method in pancreatic and biliary etiologies. In the meta-analysis, we used Forest plots, summary receiver operating characteristic curves, and estimates of the area under the curve for intention-to-treat analysis. Results: Of the 12,132 articles identified, six were included, resulting in a total of 497 patients analyzed. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and accuracy of the association between the two methods were: 86%, 98%, 12.50, 0.17, and 96.5%, respectively. For the individual analysis, the sensitivity, specificity and accuracy of EUS-FNA were 76%, 100%, and 94.5%, respectively; for ERCP-based tissue sampling, the sensitivity, specificity, and accuracy were 58%, 98%, and 78.1%, respectively. For pancreatic lesions, EUS-FNA was superior to ERCP-based tissue sampling. However, for biliary lesions, both methods had similar sensitivities. Conclusions: Same-session EUS-FNA and ERCP-based tissue sampling is superior to either method alone in the diagnosis of suspected malignant biliary strictures. Considering these results, combination sampling should be performed when possible.

Accuracy of brush cytology in biliopancreatic strictures: a single-center cohort study

“…20 It has also been shown that EUS-FNA is superior to ERCP with brush cytology for diagnosing malignant biliary strictures. 19,21,22 However, EUS-FNA also has low negative post-test probabilities. In addition, the positive rate of EUS-FNA is greatly limited by the size, location, and non-cystic nature of the tumor, as well as the ability of the operator.…”

Current status and research progress of endoscopic retrograde cholangiopancreatography in the diagnosis and treatment of biliary and pancreatic system diseases

“…9 However, the combination of two endoscopic methods for sampling is better than the two methods alone in the diagnosis of suspected malignant bile duct stenosis. 10 In recent years, with the advancement of flexible endoscopic instruments, the emergence of oral cholangiopancreatoscopy has made the bile duct directly visible.…”

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“…For indeterminate biliary stricture, the utility of EUS-guided tissue acquisition may have an important role because of the low sensitivity of endoscopic retrograde cholangiopancreatography (ERCP)-guided tissue sampling, especially brush cytology [ 24 ]. de Moura et al performed a meta-analysis of same-session procedures with EUS-guided fine-needle aspiration and ERCP-based tissue sampling for suspected malignant biliary stricture [ 25 ]. In this meta-analysis, the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and accuracy of the association between the two methods were 86%, 98%, 12.50%, 0.17%, and 96.5%, respectively.…”