Diagnostic Process Using Endoscopy for Biliary Strictures: A Narrative Review

Abstract

The diagnostic process for biliary strictures remains challenging in some cases. A broad differential diagnosis exists for indeterminate biliary strictures, including benign or malignant lesions. The diagnosis of indeterminate biliary strictures requires a combination of physical examination, laboratory testing, imaging modalities, and endoscopic procedures. Despite the progress of less invasive imaging modalities such as transabdominal ultrasonography, computed tomography, and magnetic resonance imaging, endoscopy plays an essential role in the accurate diagnosis, including the histological diagnosis. Imaging findings and brush cytology and/or forceps biopsy under fluoroscopic guidance with endoscopic retrograde cholangiopancreatography (ERCP) are widely used as the gold standard for the diagnosis of biliary strictures. However, ERCP cannot provide an intraluminal view of the biliary lesion, and its outcomes are not satisfactory. Recently, peroral cholangioscopy, confocal laser endomicroscopy, endoscopic ultrasound (EUS), and EUS-guided fine-needle aspiration have been reported as useful for indeterminate biliary strictures. Appropriate endoscopic modalities need to be selected according to the patient’s condition, the lesion, and the expertise of the endoscopist. The aim of this review article is to discuss the diagnostic process for indeterminate biliary strictures using endoscopy.

Peroral Cholangioscopy-Guided Targeted Biopsy versus Conventional Endoscopic Transpapillary Forceps Biopsy for Biliary Stricture with Suspected Bile Duct Cancer

“…Endoscopic transpapillary forceps biopsy under fluoroscopic guidance using ERCP has been widely performed to diagnose indeterminate biliary strictures. The diagnostic sensitivity and specificity for malignancy are reported to range from 43% to 81% and 90% to 100%, respectively [2][3][4][5]. A meta-analysis showed that the pooled sensitivity and specificity were 48.1% (95% CI, 42.8-53.4) and 99.2% (95% CI, 97.6-99.8), respectively [6].…”

Biliary Tree Diagnostics: Advances in Endoscopic Imaging and Tissue Sampling

“…Although bile aspiration cytology is easy to perform, it is burdened by low sensitivity (6-24%) [5,6]. Better diagnostic performances can be reached with brushing cytology, with a sensitivity and specificity for malignancy ranging between 21% and 70% and 97% and 100%, respectively [7]. In a review considering 16 studies, the overall biliary brush cytology sensitivity was 42% with a negative predictive value (NPV) of 58% [8].…”

Choledochoscopy: An update

“…However, PTCS can also be used when POC instability prevents adequate bile duct visualization[ 46 ]. When comparing POC without the use of image-enhanced function systems, DSOC has an excellent diagnostic yield in both visual impression and choledochoscopy-guided biopsies[ 40 , 47 , 48 ]. In a study by Mizrahi et al [ 47 ] involving 324 patients, DSOC had a significantly higher diagnostic yield of visual impression for malignancy than FSOC (78% vs 37%, P = 0.004).…”