Clin Endosc.  2012 Sep;45(3):328-330.

Endoscopic Ultrasonography in the Evaluation of Indeterminate Biliary Strictures

• Topazian M

Abstract

Biliary strictures may be due to a variety of benign and malignant processes. Imaging with endoscopic ultrasonography (EUS) often suggests the diagnosis, but is usually not definitive. EUS-guided fine needle aspiration (FNA) facilitates the diagnosis of extrahepatic biliary strictures, although peritioneal metastases due to needle tract seeding may occur after EUS-FNA of cholangiocarcinoma. In addition to diagnosis of strictures, EUS may play an important role in staging of cholangiocarcinoma.

Keyword

Endoscopic ultrasound; Pathologic constriction; Fine-needle biopsy; Bile ducts

MeSH Terms

Bile Ducts
Biopsy, Fine-Needle
Cholangiocarcinoma
Constriction, Pathologic
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Endosonography
Needles
Neoplasm Metastasis
Seeds

Figure

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  Fig. 1 Distal bile duct stricture caused by pancreatic head adenocarcinoma. (A) Endoscopic retrograde cholangiopancreatography shows a bile duct stricture. (B) Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) of the pancreatic head mass (arrow indicates FNA needle). (C) Cytology of the EUS-FNA specimen (papanicolaou stain, ×400). Part C courtesy of Dr. Michael Henry, M.D.

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  Fig. 2 Autoimmune pancreatitis type 1. (A) Endoscopic retrograde cholangiopancreatography shows a bile duct stricture and a long pancreatic duct stricture. (B) Endoscopic ultrasonography (EUS) of the pancreas body. (C) Histology of EUS-guided Trucut biopsy of the pancreas (H&E stain,×200). Part C courtesy of Dr. Thomas Smyrk, M.D.

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  Fig. 3 Hilar cholangiocarcinoma. (A) Endoscopic ultrasonography (EUS) of hilar bile duct mass (arrow). (B) EUS of malignant peri-duodenal node (arrow). (C) EUS of malignant peri-gastric node (arrow).

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