Gut Liver.  2018 Jul;12(4):463-470. 10.5009/gnl17205.

Prospective Comparison of Intraductal Ultrasonography-Guided Transpapillary Biopsy and Conventional Biopsy on Fluoroscopy in Suspected Malignant Biliary Strictures

• Kim HS
• Moon JH
• Lee YN
• Choi HJ
• Lee HW
• Kim HK
• Lee TH
• Choi MH
• Cha SW
• Cho YD
• Park SH

• KMID: 2417314
• DOI: http://doi.org/10.5009/gnl17205

Abstract

BACKGROUND/AIMS
In suspected malignant biliary strictures (MBSs), the diagnostic yield of endoscopic retrograde cholangiopancreatography (ERCP)-based tissue sampling is limited. Transpapillary forceps biopsy (TPB) under intraductal ultrasonography (IDUS) guidance is expected to improve the diagnostic accuracy in patients with indeterminate biliary strictures. We evaluated the usefulness of IDUS-guided TPB in patients with suspected MBS.
METHODS
Consecutive patients with suspected MBS were prospectively enrolled in the study. ERCP with IDUS was performed in all patients. Both conventional TPB and IDUS-guided TPB on fluoroscopy were performed in each patient. The primary outcome was the diagnostic accuracy of conventional TPB and IDUS-guided TPB.
RESULTS
The technical success rate of IDUS-guided TPB was 97.0% (65/67 patients). Of these 65 patients, the final diagnosis was malignancy in 61 patients (93.8%). On IDUS, the most common finding of IDUS was an intraductal infiltrating lesion in 29 patients (47.5%). The overall diagnostic accuracy was significantly higher using IDUS-guided TPB than that using conventional TPB (90.8% vs 76.9%, p=0.027). According to the subgroup analysis based on the tumor morphology, IDUS-guided TPB had a significantly higher cancer detection rate than conventional TPB for intraductal infiltrating lesions (89.6% vs 65.5%, p=0.028).
CONCLUSIONS
IDUS-guided TPB appears to improve the accuracy of histological diagnosis in patients with MBS.

Keyword

Malignant biliary stricture; Intraductal ultrasonography; Cholangiopancreatography; endoscopic retrograde; Biopsy

MeSH Terms

Biopsy*
Cholangiopancreatography, Endoscopic Retrograde
Constriction, Pathologic*
Diagnosis
Fluoroscopy*
Humans
Prospective Studies*
Surgical Instruments
Ultrasonography