Peroral cholangioscopy‐guided forceps biopsy versus fluoroscopy‐guided forceps biopsy for extrahepatic biliary lesions

Abstract

Background and Aim Endoscopic retrograde cholangiopancreatography (ERCP)‐related tissue acquisition, including fluoroscopy‐guided forceps biopsy (F‐FB), is a common technique in diagnosing indeterminate biliary lesions. Recently, peroral cholangioscopy (POCS) and POCS‐guided forceps biopsy (POCS‐FB) has also been used for the diagnosis of indeterminate biliary lesions. However, it is uncertain which of those techniques were superior for the diagnosis of extrahepatic cholangiocarcinoma (ECC). We aimed to evaluate the diagnostic yield and safety of F‐FB for indeterminate biliary lesions compared with POCS‐FB. Methods Patients who underwent F‐FB or POCS‐FB to evaluate indeterminate biliary lesions between October 2011 and August 2019 were enrolled retrospectively. We carried out propensity score matching to balance these clinical differences between the F‐FB group and POCS‐FB group. In the propensity score‐matched cohort, we compared the diagnostic performance of F‐FB with that of POCS‐FB based on the pathological evaluation. We also evaluate adverse events associated with F‐FB and POCS‐FB. Results We enrolled 113 patients with biliary diseases, and 62 patients were analyzed in the propensity score‐matched cohort. Sensitivity, specificity, and accuracy of F‐FB were 82.4, 100, and 90.3%, and for POCS‐FB, those values were 83.3, 100, and 90.3%, respectively. There were no significant differences in the diagnostic performance between F‐FB and POCS‐FB. There were also no significant differences in the occurrence of adverse events between F‐FB and POCS‐FB (41.9 vs 29.0%, P = 0.289). Conclusions The diagnostic yield of F‐FB for ECC is similar to that of POCS‐FB. POCS‐FB is not necessary for the initial pathological diagnosis of indeterminate biliary lesions.

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

“…However, some studies did show relatively low sensitivity [19]. Some previous studies have directly compared the diagnostic results of POCS-guided biopsy with those of conventional endoscopic transpapillary biopsy under fluoroscopic guidance (Table 5) [20][21][22]. One study showed that the diagnostic sensitivity of POCS-guided biopsy was significantly better than that of fluoroscopy-guided biopsy [20].…”

Choledochoscopy: An update

“…For the acquisition of larger tissue samples, the SpyBite Max biopsy forceps acquire twice the amount of tissue than the SpyBite biopsy forceps[ 9 ]. This is particularly promising given how the diagnostic accuracy of biopsy samples of IBS obtained via the legacy SpyBite biopsy forceps has been hampered by inadequate tissue samples[ 28 ].…”

“…Firstly, choledochoscopy-guided tissue samples are often too small for accurate offsite histopathological examination and thus decrease sensitivity. Adequate tissue acquisition is primarily limited by the technical ability of choledochoscopy forceps jaw[ 28 ]. Other factors include age less than 65 years old (OR = 0.170, 95%CI: 0.044–0.649, P = 0.010) and previous biliary stenting before POC (OR = 0.199, 95%CI: 0.053–0.756, P = 0.017)[ 56 ].…”

“…Additional biopsies for offsite specimen processing did not improve diagnostic accuracy. However, other retrospective studies by Onoyama et al [ 28 ] and Varadarajulu et al [ 59 ] recommend minimally four biopsies when using offsite and onsite[ 60 ] processing techniques, respectively. Furthermore, Varadarajulu et al [ 59 ] observed that extrinsic strictures required more biopsies than intrinsic strictures for onsite processing techniques.…”

Comparison of the Diagnostic Performance of Novel Slim Biopsy Forceps with Conventional Biopsy Forceps for Biliary Stricture: A Multicenter Retrospective Study

“…In addition to aspiration cytology or brush cytology, which may not theoretically provide a sufficient specimen, endobiliary forceps biopsy can be used to collect a histological core specimen that extends deep into the epithelium [ 4 ]. However, a select series that evaluated endobiliary forceps biopsies for malignant biliary strictures revealed sensitivity values of 43–82% and negative predictive values of 31–82% [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. A recent meta-analysis [ 13 ] revealed that the pooled sensitivity and specificity of an endobiliary forceps biopsy for the diagnosis of malignant biliary stricture were 48.1% and 99.2%, respectively.…”