Transpapillary tissue sampling of biliary strictures: balloon dilatation prior to forceps biopsy improves sensitivity and accuracy

Pörner, Daniel; Kaczmarek, Dominik J.; Heling, Dominik; Hausen, A; Mohr, Raphael; Hüneburg, Robert; Matthaei, Hanno; Glowka, Tim R.; Manekeller, Steffen; Fischer, Hans‐Peter; Toma, Marieta; Nattermann, Jacob; Strassburg, Christian P.; Gonzalez‐Carmona, Maria A.; Weismüller, Tobias J.

doi:10.1038/s41598-020-74451-9

Cited by 10 publications

(9 citation statements)

References 29 publications

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“…As was the case in this study, intrinsic stenosis is more frequently proximal than distal 22 . As previous biliary stricture dilation 23 24 25 or biliary aspiration 26 27 may optimize the sensitivity of brushing, we proposed performing these procedures during ERCP. Such optimization of the standard brushing via previous biliary stricture dilation or biliary aspiration could explain the relatively high sensitivity rate of 67 % with the standard RX Cytology Brush in this study.…”

Section: Discussionmentioning

confidence: 99%

Multicenter randomized trial comparing diagnostic sensitivity and cellular abundance with aggressive versus standard biliary brushing for bile duct stenosis without mass syndrome

Karsenti¹,

Privat

Charissoux³

et al. 2023

Endoscopy

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Background and aims Diagnosis of cholangiocarcinoma in case of biliary stricture without mass syndrome is obtained by biliary brushing with approximately 50% sensitivity. We performed a multicenter randomized crossover trial comparing the aggressive Infinity brush with the standard RX Cytology Brush. The aims were sensitivity for cholangiocarcinoma diagnosis and cellularity abundance. Methods 51 patients were included. Biliary brushing was performed consecutively with each brush, in a randomized order. Cytological material was studied in a blinded manner concerning the brush. The primary endpoint was sensitivity for cholangiocarcinoma diagnosis, and the secondary endpoint was the abundance of the cellularity obtained with each brush. Cellularity was quantified, in order to determine if one brush strongly outperformed the other. Results Final diagnosis was cholangiocarcinoma (n = 43, 84%), benign (n = 7, 14%) and indeterminate (1 case). Sensitivity for cholangiocarcinoma was 34/43 (79%) for the Infinity brush versus 29/43 (67%) for the RX Cytology Brush (p = 0.096). Cellularity was rich in 31/51 (61%) cases with the Infinity brush and in 10/51 (20%) cases with the RX Cytology Brush (p < 0.001). In terms of cellularity quantification, the Infinity brush strongly outperformed the RX Cytology Brush in 28/51 cases (51%), while the RX Cytology Brush strongly outperformed the Infinity brush in 4/51 cases (8%) (p < 0.001). <b>Conclusions</b> This randomized crossover trial shows that the Infinity brush is not significantly more effective than the RX Cytology Brush for biliary stenosis without mass syndrome in terms of sensitivity for cholangiocarcinoma but does allow significantly higher cellularity abundance. <b>ClinicalTrials.gov ID: NCT04251013</b>

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Section: Discussionmentioning

confidence: 99%

Multicenter randomized trial comparing diagnostic sensitivity and cellular abundance with aggressive versus standard biliary brushing for bile duct stenosis without mass syndrome

Karsenti¹,

Privat

Charissoux³

et al. 2023

Endoscopy

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“…Several techniques in tissue sampling have been shown to improve the diagnostic accuracy of ERCP-based tissue sampling. Balloon dilatation of the biliary stricture prior to forcep biopsy improved the sensitivity from 40% to 71% and was not associated with a higher complication rate [12]. In a pilot study, post-brushing biliary lavage fluid cytology by injecting 5-15 mL of saline into the bile duct after brushing improved the cumulative sensitivity by 24% [13].Fluorescence in situ hybridization (FISH) has been used to measure the DNA content of potential oncogenic genes on brush cytology samples for over a decade.…”

Section: Cholangiogram Appearance Brush Cytology and Transpapillary B...mentioning

confidence: 93%

The Role of Cholangioscopy and EUS in the Evaluation of Indeterminate Biliary Strictures

Siu

Tang

2022

Gastroenterology Insights

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Bile duct stenosis continues to present a diagnostic dilemma for clinicians. It is important to establish the benign or malignant nature of the stricture early in order to avoid any unnecessary delay in medical treatment or surgery. Tissue acquisition for histological diagnosis is particularly crucial when the initial diagnostic work up is inconclusive. The diagnostic yield from the conventional endoscopic retrograde cholangiopancreatography (ERCP) with brushing and biopsy is suboptimal. Patients with indeterminate biliary strictures (IDBSs) often require a multi-disciplinary diagnostic approach and additional endoscopic evaluation, including cholangioscopy and endoscopic ultrasound, before a final diagnosis can be reached. In this article, we discuss the recent endoscopic advancements in the diagnosis of biliary stricture with a focus on the roles of cholangioscopy and endoscopic ultrasound (EUS).

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“…Several techniques have been proposed to enhance tissue acquisition during ERCP, such as the use of novel brushes, biliary stricture dilation followed by biopsies and brushing, and repetitive brushings. Pörner et al [ 9 ] have suggested that balloon dilation of the stricture before forceps biopsies can improve sensitivity from 40% to > 70% without increasing the complication rate. In another study by Sugimoto et al [ 10 ] post brushing biliary lavage fluid was obtained by injecting small amount of saline into bile duct.…”

Section: Endoscopic Management Of Idbssmentioning

confidence: 99%

Clinical approach to indeterminate biliary strictures: Clinical presentation, diagnosis, and workup

Yadlapati,

Mulki,

Sánchez-Luna

et al. 2023

World J Gastroenterol

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The liver is one of the organs most commonly involved in metastatic disease, especially due to its unique vascularization. It’s well known that liver metastases represent the most common hepatic malignant tumors. From a practical point of view, it’s of utmost importance to evaluate the presence of liver metastases when staging oncologic patients, to select the best treatment possible, and finally to predict the overall prognosis. In the past few years, imaging techniques have gained a central role in identifying liver metastases, thanks to ultrasonography, contrast-enhanced computed tomography (CT), and magnetic resonance imaging (MRI). All these techniques, especially CT and MRI, can be considered the non-invasive reference standard techniques for the assessment of liver involvement by metastases. On the other hand, the liver can be affected by different focal lesions, sometimes benign, and sometimes malignant. On these bases, radiologists should face the differential diagnosis between benign and secondary lesions to correctly allocate patients to the best management. Considering the above-mentioned principles, it’s extremely important to underline and refresh the broad spectrum of liver metastases features that can occur in everyday clinical practice. This review aims to summarize the most common imaging features of liver metastases, with a special focus on typical and atypical appearance, by using MRI.

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Transpapillary tissue sampling of biliary strictures: balloon dilatation prior to forceps biopsy improves sensitivity and accuracy

Cited by 10 publications

References 29 publications

Multicenter randomized trial comparing diagnostic sensitivity and cellular abundance with aggressive versus standard biliary brushing for bile duct stenosis without mass syndrome

Multicenter randomized trial comparing diagnostic sensitivity and cellular abundance with aggressive versus standard biliary brushing for bile duct stenosis without mass syndrome

The Role of Cholangioscopy and EUS in the Evaluation of Indeterminate Biliary Strictures

Clinical approach to indeterminate biliary strictures: Clinical presentation, diagnosis, and workup

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