The combination of stricture dilation, endoscopic needle aspiration, and biliary brushings significantly improves diagnostic yield from malignant bile duct strictures

Farrell, Richard J.; Jain, Ajay; Brandwein, Steven L.; Wang, Helen; Chuttani, Ram; Pleskow, Douglas K.

doi:10.1067/mge.2001.118715

Cited by 148 publications

(92 citation statements)

References 23 publications

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“…Among these, 40 patients were confirmed to have malignant neoplasia: pancreatic adenocarcinoma (18), cholangiocarcinoma (17), gallbladder cancer (2), metastases (2) and neuroendocrine carcinoma of the pancreas (1). Inflammatory disease was observed after a mean follow-up of 29 months (range 17-39 months) in 10 patients: chronic pancreatitis (6) and inflammatory stenosis secondary to bile duct stones (4).…”

Section: Resultsmentioning

confidence: 99%

“…Reliable differentiation between benign and malignant etiology remains a challenge. Acquiring tissue from such lesions during ERCP is the classical approach since affected patients are commonly evaluated and primarily treated during ERCP (4) . Features that affect cancer detection rate on cytology samples are adequacy and processing, slides interpretation and tumor type (2) .…”

Section: Discussionmentioning

confidence: 99%

“…Many patients are considered unsuitable for surgery due to locally advanced disease, metastatic neoplasia or high surgical risk (2) . Accurate diagnosis is essential if surgery is to be considered or indeed for placement of self-expandable metallic stent in inoperable situations (4) . Furthermore, for considering patients to palliative chemo or radiotherapy a tissue or cytological diagnosis is often required (2) .…”

Section: Introductionmentioning

confidence: 99%

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Comparison between endoscopic brush cytology performed before and after biliary stricture dilation for cancer detection

Ornellas¹,

Santos

Nakao³

et al. 2006

Arq. Gastroenterol.

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-Background -Confirmation of malignancy within biliary strictures is endoscopically challenging. Dilation of strictures has been reported to enhance cytological diagnosis. Aim -To compare brush cytology results before and after biliary stricture dilation. Patients and Methods -Patients with extra-hepatic biliary stricture at endoscopic retrograde cholangiopancreatography were included in the study. Brushing was performed before and immediately after dilation using a 10 Fr dilating catheter. Cytology samples were classified as: negative for malignancy, presence of atypical cells, insufficient material, suspicious for malignancy or positive for malignancy. Final diagnosis was established by surgery, biopsy or followup. Results -Biliary brush cytology was performed in 50 patients, with an overall sensitivity of 40% and 27.5%, before and after dilation, respectively. The combination of results increased cancer detection rate to 45%. There were 5/50 (10%) minor complications and one death related to the procedure. Conclusions -Brush cytology performed before biliary stricture dilation has a similar cancer detection rate to that following dilation, although the combination of results enhances sensitivity.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison between endoscopic brush cytology performed before and after biliary stricture dilation for cancer detection

Ornellas¹,

Santos

Nakao³

et al. 2006

Arq. Gastroenterol.

View full text Add to dashboard Cite

show abstract

“…One reason for this finding might be the distortion of the stricture by the SpyGlass  system. Balloon predilation was previously reported to significantly improve the diagnostic yield of BC [8]. Sugimoto et al [26] recently reported that the diagnostic efficacy of cytological evaluation of post-brushing biliary lavage fluid was superior to that of BC in bile duct cancer (75% vs. 49%).…”

Section: Discussionmentioning

confidence: 99%

“…Low cellular yields are considered as the primary reason for the low sensitivity of brush cytology. Hence, various techniques have been employed to improve the sensitivity of biliary lesion diagnosis, including fluorescence in situ hybridization [4], increasing cellular yield via application of a new brush type [5,6], a new cell block technique [7], and a pre-dilation technique to disrupt strictures [8].…”

Section: Introductionmentioning

confidence: 99%