Gut Liver.  2016 Jul;10(4):642-648. 10.5009/gnl15231.

The Wire-Grasping Method as a New Technique for Forceps Biopsy of Biliary Strictures: A Prospective Randomized Controlled Study of Effectiveness

• Yamashita
• Ueda K
• Kawaji Y
• Tamura T
• Itonaga M
• Yoshida T
• Maeda H
• Magari H
• Maekita T
• Iguchi M
• Tamai H
• Ichinose M
• Kato J

• KMID: 2412055
• DOI: http://doi.org/10.5009/gnl15231

Abstract

BACKGROUND/AIMS
Transpapillary forceps biopsy is an effective diagnostic technique in patients with biliary stricture. This prospective study aimed to determine the usefulness of the wire-grasping method as a new technique for forceps biopsy.
METHODS
Consecutive patients with biliary stricture or irregularities of the bile duct wall were randomly allocated to either the direct or wire-grasping method group. In the wire-grasping method, forceps in the duodenum grasps a guide-wire placed into the bile duct beforehand, and then, the forceps are pushed through the papilla without endoscopic sphincterotomy. In the direct method, forceps are directly pushed into the bile duct alongside a guide-wire. The primary endpoint was the success rate of obtaining specimens suitable for adequate pathological examination.
RESULTS
In total, 32 patients were enrolled, and 28 (14 in each group) were eligible for analysis. The success rate was significantly higher using the wire-grasping method than the direct method (100% vs 50%, p=0.016). Sensitivity and accuracy for the diagnosis of cancer were comparable in patients with the successful procurement of biopsy specimens between the two methods (91% vs 83% and 93% vs 86%, respectively).
CONCLUSIONS
The wire-grasping method is useful for diagnosing patients with biliary stricture or irregularities of the bile duct wall.

Keyword

Biliary tract; Endoscopic transpapillary biopsy; Biliary strictures; Surgical instruments; Sphincterotomy

MeSH Terms

Aged
Aged, 80 and over
Ampulla of Vater/surgery
Bile Ducts/pathology/surgery
Biliary Tract Surgical Procedures/*instrumentation/*methods
Biopsy/instrumentation/methods
Cholestasis/*diagnosis/pathology
Constriction, Pathologic/diagnosis
Duodenum/surgery
Female
Humans
Male
Middle Aged
Prospective Studies
Sensitivity and Specificity
*Surgical Instruments