EUS-guided FNA for biliary disease as first-line modality to obtain histological evidence

Abstract

Background: Few reports have described endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) for biliary lesions. In addition, adverse events were not completely examined in previous reports, due to the inclusion of cases in which biliary stents had already been placed. The present study aimed to investigate the diagnostic yield and adverse events of EUS-FNA for biliary lesions as the first-line diagnostic modality for consecutive prospectively registered patients. Methods: Inclusion criteria were as follows: (1) patients with suspected cholangiocarcinoma (CCA) based on computed tomography or other imaging modalities; (2) patients who had not previously undergone endoscopic retrograde cholangiopancreatography or EUS-FNA; (3) absence of surgically altered anatomy, such as Roux-en-Y anastomosis or duodenal obstruction caused by tumor invasion, through which an endoscope could not pass; and (4) provision of written informed consent to all procedures associated with the study. Results: A total of 47 consecutive patients with suspected CCA were registered to this study. Sensitivity and accuracy were 89% and 87%, respectively. On multivariate analysis, puncture site was the only factor associated with reduced diagnostic yield (hazard ration, 6.879; 95% confidence interval, 1.172–40.374; P = 0.033). Remarkably, no adverse events such as bleeding or bile leakage were associated with EUS-FNA in any of the 47 patients. Conclusions: Our results suggest that EUS-FNA can be safely performed for biliary disease without biliary stenting. Furthermore, this procedure may warrant use as the first-line diagnostic method, although our results need to be validated in future prospective studies.

Review article: Asia‐Pacific consensus recommendations on endoscopic tissue acquisition for biliary strictures

“…Selection of modality being more cost‐effective as the initial diagnostic tool for biliary stricture or as a “rescue” method for indeterminate biliary strictures is largely unclear. However, it appears reasonable to combine different techniques within 1 procedure to maximise the diagnostic yield, reduce false‐negative results and the number of endoscopic procedures …”

“…It is considered appropriate to perform EUS‐FNA on distal bile duct lesions, unresectable biliary malignancies, or lesions causing extrinsic compression. A prospective study of 47 patients revealed that EUS‐FNA can be safely performed as a first‐line diagnostic modality for suspected cholangiocarcinoma with a satisfactory diagnostic sensitivity (89%) and accuracy (87%) . If initial EUS‐guide sampling proves nondiagnostic then a subsequent ERCP‐based intraductal tissue sampling can be taken.…”

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

“…EUS can provide many additional information and help stage the lesion, which is a determining factor for tumor ressectability 8 21 22 .…”

“…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.…”

Endoscopic Perspective in Cholangiocarcinoma Diagnostic Process

“…The possibility of using EUS-FNA as a safer alternative to ERCP was also investigated. For instance, Onda et al performed EUS-FNA as the first-line method in patients with suspected ECCA based on CT or other imaging modalities with sensitivity of 89% and accuracy of 87% [79]. In a recent meta-analysis, De Moura et al calculated the mean sensitivi-ties of ERCP and EUS-FNA for the tissue diagnosis of a malignant biliary stricture to be 49% and 75%, while specificities were 96% and 100% [80].…”