ENDOSCOPIC TRANSPAPILLARY BILE-DUCT BIOPSY WITHOUT SPHINCTEROTOMY FORDIAGNOSING BILIARY STRICTURES - A PROSPECTIVE COMPARATIVE-STUDY WITH BILE AND BRUSH CYTOLOGY

Objectives: Endoscopic transpapillary bile duct biopsy has a high sens itivity for detection of malignant biliary strictures, but is commonly performed after endoscopic sphincterotomy, We performed transpapillar y biopsy without sphincterotomy, using a recently developed, malleable biopsy forceps, and prospectively studied the usefulness of this diag nostic procedure, compared with that of bile and brush cytology, Metho ds: We succeeded in transpapillary biopsy without sphincterotomy in 45 (87%) of 52 patients, In 43 patients with biliary strictures (31 mali gnant, 12 benign) who successfully underwent all endoscopic samplings by bile aspiration, brushing, and biopsy, the diagnostic value of thes e three sampling methods was compared, Results: Transpapillary biopsy (81%) had a significantly higher level of sensitivity for malignancy t han bile (32%) and brush (48%) cytology, Transpapillary biopsy was mor e sensitive for bile duct cancer (88%) than for pancreatic cancer (71% ), as were cytology techniques, No false positives were found in any o f the three sampling methods, No complications accompanied the endosco pic procedures, Conclusions: Transpapillary bile duct biopsy without s phincterotomy is a simple, safe, and effective technique for diagnosin g biliary stricture, We recommend that this technique be performed rou tinely at initial endoscopic retrograde cholangiopancreatography for p atients with a stricture or filling defect of the extrahepatic bile du ct.