ENDOSCOPIC RETROGRADE FORCEPS BIOPSY AND BRUSH CYTOLOGY OF BILIARY STRICTURES - A PROSPECTIVE-STUDY

Background: Nonsurgical pathologic confirmation of malignant bile duct strictures is desirable for defining subsequent treatment and prognos is. Endoscopic retrograde cholangiopancreatography is frequently perfo rmed in patients suspected of having pancreaticobiliary obstruction, b ut there exists no standardized method for defining the nature of obst ructing lesions by ERCP. Methods: We prospectively evaluated the yield s of endoscopic retrograde brush cytology and biopsy for the diagnosis of malignant bile duct strictures. Fluoroscopically guided endobiliar y biopsy and brush cytology (52) or cytology alone (42) were performed during endoscopic retrograde cholangiopancreatography in 94 consecuti ve patients, 64 with malignant strictures and 30 with benign stricture s. A single cytopathologist classified the results of these studies as positive or negative for malignancy. Results: The sensitivities of th e two procedures were identical (53%) and the gain achieved by combini ng the two techniques (61%) was small. Specificity proved excellent fo r both methods. One major complication that occurred was perforation o f the common hepatic duct with leakage of bile, which was managed by s urgical oversewing. This complication was ascribed to biopsy and untim ely removal of the nasobiliary drain by the patient herself. Conclusio ns: This study indicates that endoscopic retrograde brush cytology alo ne may be sufficient in daily practice, at least in centers that have access to experienced cytopathologists. We recommend use of forceps bi opsy in selected cases where brush cytology is negative.