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

Background. Brush cytology, routinely performed at ERCP to assess malignant -appearing biliary strictures, is limited by relatively low sensitivity and negative predictive value. This study assessed whether the combination of stricture dilation, endoscopic needle aspiration, and biliary brushing impr oves diagnostic yield. Methods. In a prospective nonrandomized study, 46 consecutive patients were evaluated with malignant-appearing biliary strictures at ERCP. Twenty-four patients (Group A) underwent standard brush cytology alone and 22 patients (Group B) underwent stricture dilatation to 10F, endoscopic needle aspirat ion, and subsequent biliary brushing by using the Howell biliary system. Th e diagnostic yields for both techniques were compared. Results: Of the 46 patients, 34 had proven malignant strictures (14 Group A , 20 Group B). Compared with brushing alone, the combination of stricture d ilatation, endoscopic needle aspiration, and subsequent biliary brushing si gnificantly increased both the sensitivity (57% vs. 85%, p < 0.02) and spec ificity (80% vs. 100%, p < 0.02) of cytology with positive brushings in all patients with pancreatic or gallbladder carcinoma. Conclusions. The combination of stricture dilation, endoscopic needle aspir ation, and biliary brushing significantly improves diagnostic yield for mal ignant bile duct strictures and may particularly be of benefit for extrinsi c strictures caused by pancreatic or gallbladder carcinoma.