ENDODUCTAL TISSUE SAMPLING OF BILIARY STRICTURES THROUGH ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP)

Aim and background: Pathological proof of malignant in biliary strictu res is useful in the preoperative setting as it helps define therapeut ic planning and prognosis, and reduces the length of the subsequent su rgical intervention. However, it is difficult to obtain. The aim of th is study was to evaluate the yield of histological and cytological exa mination of endobiliary samples obtained during endoscopic retrograde cholangiopancreatography (ERCP). Methods: Endobiliary forceps biopsy a nd brush cytology were performed during ERCP examination in 52 consecu tive patients, 36 with malignant and 16 with benign strictures, Result s: Histology and cytology turned out to have the same sensitivity (53% ). The gain in sensitivity achieved by combining the two techniques wa s limited, reaching a value of 61%. The specificity, however, was 100% for both methods. Most of the few complications observed were due to sphincterotomy and subsided spontaneously or with medical treatment. H owever, one patient experienced a serious complication and chose to be treated by surgical intervention. The complication was caused by forc eps biopsy. Conclusions: This study shows that 1) sampling of biliary strictures during ERCP is the primary approach to tissue diagnosis; 2) brush cytology alone is sufficient in clinical practice; 3) forceps b iopsy must always be used to sample Intra-ampullary strictures but sho uld be considered as a secondary step to sample strictures located mor e proximally, in the bile ducts, if previous cytology was negative.