Update on biliary endoscopy

Joyce, Ann Marie; Kochman, Michael L.

doi:10.1097/01.mog.0000158113.67087.8b

Cited by 11 publications

(10 citation statements)

References 39 publications

(21 reference statements)

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“…This indicates that, despite improved imaging techniques, it is still difficult to differentiate benign from malignant biliary strictures reliably. It is possible that cholangioscopic biopsy decreases false-positive results and may be the way to go in future 14 .…”

Section: Discussionmentioning

confidence: 96%

Immunoglobulin G4-related sclerosing cholangitis in patients resected for presumed malignant bile duct strictures

Erdogan

Kloek

Kate

et al. 2008

British Journal of Surgery

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Section: Discussionmentioning

confidence: 96%

Immunoglobulin G4-related sclerosing cholangitis in patients resected for presumed malignant bile duct strictures

Erdogan

Kloek

Kate

et al. 2008

British Journal of Surgery

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“…Unfortunately, the diagnostic yield is poor with sensitivity rates around 50% [9,26] . Moreover, the specificity is not 100% since longstanding stenting of the biliary duct induces chronic inflammation, which makes it difficult to differentiate benign from malignant cells, resulting in false positive results [9] .…”

Section: Discussionmentioning

confidence: 99%

Differentiation of malignant and benign proximal bile duct strictures: The diagnostic dilemma

Kloek¹,

Delden²,

Erdogan³

et al. 2008

WJG

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AIM:To identify the criteria for the differentiation of hilar cholangiocarcinoma (HCCA) from benign strictures. METHODS: A total of 68 patients underwent resection of lesions suspicious for HCCA between 1998 and 2006. The results of laboratory investigations, imaging studies and brush cytology were collected. These findings were analyzed to obtain the final diagnosis. RESULTS: Histological examination of the resected specimens confirmed HCCA in 58 patients (85%, group Ⅰ) whereas 10 patients (15%, group Ⅱ) were diagnosed to have benign strictures. The most common presenting symptom was obstructive jaundice in 77% patients (79% group Ⅰ vs 60% group Ⅱ, P = 0.23). Laboratory findings showed greater elevation of transaminase levels in group Ⅰ compared to group Ⅱ. The various imaging modalities showed vascular involvement exclusively in the malignant group (36%, P < 0.05). Brush cytology was positive for malignant cells in only 50% patients in group Ⅰ whereas none in group Ⅱ showed malignant cells. CONCLUSION: Despite improvements in imaging techniques, 10 patients (15%) with a presumptive diagnosis of HCCA were ultimately found to have benign strictures. Except for vascular involvement which was associated significantly with malignancy, there were no conclusive features of malignancy on regular imaging modalities. This uncertainty should be taken into account when patients with a suspicious lesion at the liver hilum are considered for resection.

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“…The incidence of post-sphincterotomy bleeding reported in the literature widely varies because of differences in definition and may reach up to 10 % [1].…”

Section: Discussionmentioning

confidence: 99%

Fully Covered Self-expandable Metal Stents for Treatment of Post-sphincterotomy Bleeding

Samie¹,

Theilmann²

2012

Z Gastroenterol

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Endoscopic biliary sphincterotomy (ES) is the cornerstone of therapeutic endoscopic retrograde cholangiopancreatography (ERCP); however, serious complications are not uncommon. Post-sphincterotomy bleeding is one of the most frequent complications following ES and may occur in up to 10% of the patients. The spectrum of presentation may range from self-limited to severe live threatening hemorrhage. Different endoscopic treatment options are available. Angiographic embolisation and surgery are preserved for refractory cases not controlled by endoscopic means. Recently, completely covered self-expandable metal stents (CSEMS) have been applied to achieve hemostasis in severe post-sphincterotomy bleeding not controlled by other measures. We present our experience with this method to control delayed bleeding after ES in two patients requiring continuous therapeutic anticoagulation due to high cardiovascular embolic risk.

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Update on biliary endoscopy

Abstract: This review focuses on some of the work being performed in the field of biliary endoscopy. The key studies were chosen to highlight some of the areas currently being investigated as well as to indicate certain fields that need further development.

Cited by 11 publications

References 39 publications

Immunoglobulin G4-related sclerosing cholangitis in patients resected for presumed malignant bile duct strictures

Immunoglobulin G4-related sclerosing cholangitis in patients resected for presumed malignant bile duct strictures

Differentiation of malignant and benign proximal bile duct strictures: The diagnostic dilemma

Fully Covered Self-expandable Metal Stents for Treatment of Post-sphincterotomy Bleeding

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