Recent advances of diagnostic approaches for indeterminate biliary tract obstruction

Abstract

Patients with indeterminate biliary stricture frequently pose a challenge in the clinical management. Discrimination between benign and malignant biliary strictures is important to prevent the morbidity and mortality associated with incorrect diagnoses. 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 and molecular techniques have the potential to improve the diagnostic and prognostic accuracy of biliary strictures. This article reviews various etiologies of biliary strictures and discusses the recent advances of diagnostic approaches for indeterminate biliary tract obstruction.

The Role of Cholangioscopy and EUS in the Evaluation of Indeterminate Biliary Strictures

“…The European Society of Gastrointestinal Endoscopy suggests that a combination of IDUS and biopsies might have a role in the evaluation of ampullary tumors [17]. However, despite the strengths of IDUS, several limitations exist: (1) the tendency for under-staging of pancreatobiliary tract tumors and suboptimal staging for locoregional lymph nodes due to the limited penetration depth [37], (2) decreased diagnostic yield due to acoustic interference from previously placed biliary stents and (3) most importantly the inability to obtain a histological sample [39].…”