Estudo prospectivo e comparativo do escovado obtido pela CPER à ecoendoscopia associada à punção aspirativa com agulha fina (EE-PAAF) no diagnóstico diferencial das estenoses biliares

Novis, Monica; Ardengh, José Celso; Líbera, Ermelindo Della; Nakao, Frank Shigueo; Ornellas, Laura C.; Santo, Giulio Cesare; Venco, Filadelfio; Ferrari, Ângelo Paulo

doi:10.1590/s0100-69912010000300006

Cited by 11 publications

(10 citation statements)

References 32 publications

(56 reference statements)

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“…Apparently, the association of methods could increase the number of complications, because a patient would undergo more than 1 procedure. Despite this, our study like others, demonstrated similar complication rates in comparison with studies in which both methods were not performed 24 25 26 27 .…”

Section: Discussionsupporting

confidence: 72%

“…In the literature, there are 4 studies 24 25 26 27 similar to our study in which ERCP tissue sampling and EUS-FNA were performed on the same day. In 2 of these studies, 25 26 only ERCP-BB was performed and in the other 2 24 27 as well as our study, ERCP-BB and ERCP-FB were performed.…”

Section: Discussionmentioning

confidence: 53%

“…The use of 2 experienced pathologists contributed to our good results, because several studies have demonstrated an improvement in accuracy and sensitivity when evaluation is done by an experienced pathologist 25 28 .…”

Section: Discussionmentioning

confidence: 88%

“…EUS-FNA’s sensitivity in biliary strictures is heterogeneous, varying from 46 % to 100 % 5 21 22 23 24 25 26 27 , and specifically for intraductal lesions between 53 % and 89 % 6 23 24 . Our study demonstrated good sensitivity for the method, with a sensitivity of 93.8 % on the global analysis, 100 % in extraductal lesions and 80 % in intraductal lesions.…”

Section: Discussionmentioning

confidence: 99%

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EUS-FNA versus ERCP for tissue diagnosis of suspect malignant biliary strictures: a prospective comparative study

Moura

Matuguma

et al. 2018

Endosc Int Open

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Background and study aims Biliary strictures are frequently a challenging clinical scenario and the anatomopathological diagnosis is essential in the therapeutic management, whether for curative or palliative purposes. The acquisition of specimens is necessary since many benign diseases mimic biliopancreatic neoplasms. Endscopic retrograde cholangiopancreatography (ERCP) is the traditionally used method despite the low sensitivity of biliary brush cytology and forceps biopsy. On the other hand, several studies reported good accuracy rates using endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). The aim of this prospective study was to compare, the accuracy of EUS-FNA and ERCP for tissue sampling of biliary strictures. Patients and methods After performing the sample size calculation, 50 consecutive patients with indeterminate biliary strictures were included to undergo ERCP and EUS on the same sedation.The gold-standard was surgery or 6 months’ follow-up. Evaluation of the diagnostic indices (sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio), concordance and adverse events among the methods were performed. Also, subtype analyses of the techniques, anatomical localization and size of the lesion were included. Results The final diagnoses reported in 50 patients were 47 malignant, 1 suspicious and 2 benign lesions. 31 lesions were extraductal and 19 intraductal, 35 were distal and 15 proximal strictures. In the intention-to-treat analysis, the sensitivity and accuracy of EUS-FNA were superior than ERCP tissue sampling (93,8 %, 94 % vs. 60,4 %, 62 %, respectively) ( P = 0.034), with similar adverse events. There was no concordance between the methods and combining both methods improved the sensitivity and accuracy for 97.9 % and 98 %, respectively. In the subtype analyses, the EUS-FNA was superior, with a higher accuracy than ERCP tissue sampling in evaluating extraductal lesions (100 % vs. 54.8 %, P = 0.019) and in those larger than 1.5 cm (95.8 % vs. 61.9 %, P = 0.031), but were similar in evaluating intraductal lesions and lesions smaller than 1.5 cm. There was no significant difference between the methods in the analyzes of proximal, distal and pancreatic lesions. Conclusion EUS-FNA is better than ERCP with brush cytology and intraductal forceps biopsy in diagnosing malignant biliary strictures, mainly in the assessment of extraductal lesions and in those larger than 1.5 cm. Combining ERCP with tissue sampling and EUS-FNA is feasible, the techniques have similar complication rates, and the combination greatly improves diagnostic accuracy.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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EUS-FNA versus ERCP for tissue diagnosis of suspect malignant biliary strictures: a prospective comparative study

Moura

Matuguma

et al. 2018

Endosc Int Open

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“…The incidence varies based on geography, and the highest rates are seen in Southeast Asia. [ 5 6 7 ]…”

Section: Introductionmentioning

confidence: 99%

Endoscopic retrograde cholangiopancreatography versus endoscopic ultrasound for tissue diagnosis of malignant biliary stricture: Systematic review and meta-analysis

Moura

Bernardo

et al. 2018

Endosc Ultrasound

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Background and Aims:There are no systematic reviews comparing the use of endoscopic retrograde cholangiopancreatography (ERCP)-based brush cytology and forceps biopsy and endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) for the diagnosis of malignant biliary stricture; so in this revision, we will compare ERCP against EUS-FNA for tissue diagnosis of malignant biliary stricture.Design:A systematic review was conducted of comparative studies (prospective or retrospective) analyzing EUS and ERCP for tissue diagnosis of malignant biliary stricture.Materials and Methods:The databases Medline, EMBASE, Cochrane, LILACS, CINAHL, and Scopus were searched for studies dated previous to November 2014. We identified three prospective studies comparing EUS-FNA and ERCP for the diagnosis of malignant biliary stricture and five prospective studies comparing EUS-FNA with the same diagnosis of the other three studies. All patients were subjected to the same gold standard method. We calculated study variables (sensitivity, specificity, prevalence, positive and negative predictive values, and accuracy) and performed a meta-analysis using the Review Manager (RevMan) 5.3 software.Results:A total of 294 patients were included in the analysis. The pretest probability for malignant biliary stricture was 76.66%. The mean sensitivities of ERCP and EUS-FNA for tissue diagnosis of malignant biliary stricture were 49% and 75%, respectively; the specificities were 96.33% and 100%, respectively. The posttest probabilities positive predictive value (98.33% and 100%, respectively) and negative predictive value (34% and 47%, respectively) were determined. The accuracies were 60.66% and 79%, respectively.Conclusion:We found that EUS-FNA was superior to ERCP with brush cytology and forceps biopsy for diagnosing malignant biliary strictures. However, a negative EUS-FNA or ERCP test may not exclude malignant biliary stricture because both have low negative posttest probabilities.

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Diagnostic yield of EUS-guided FNA for malignant biliary stricture: a systematic review and meta-analysis

Sadeghi

Mohamadnejad

Islami

et al. 2016

Gastrointestinal Endoscopy

105

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Estudo prospectivo e comparativo do escovado obtido pela CPER à ecoendoscopia associada à punção aspirativa com agulha fina (EE-PAAF) no diagnóstico diferencial das estenoses biliares

Abstract: Both, ERCP brush cytology and EUS-FNA has a similar yield for the diagnosis of biliary strictures. However, the combination of these methods results in an improved diagnostic accuracy. In addition, GIP might be expected to interpret specimens with greater accuracy than GP.

Cited by 11 publications

References 32 publications

EUS-FNA versus ERCP for tissue diagnosis of suspect malignant biliary strictures: a prospective comparative study

EUS-FNA versus ERCP for tissue diagnosis of suspect malignant biliary strictures: a prospective comparative study

Endoscopic retrograde cholangiopancreatography versus endoscopic ultrasound for tissue diagnosis of malignant biliary stricture: Systematic review and meta-analysis

Diagnostic yield of EUS-guided FNA for malignant biliary stricture: a systematic review and meta-analysis

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