Aims and objectives
•Biliary strictures represent a challenging diagnostic and therapeutic dilemma.
•Such strictures are related to cholangiocarcinoma,
but in 10%–25% of cases,
they could be related to benign lesions or other malignancies,
which may mimic the clinical and radiological pattern of hilar cholangiocarcinoma.
•Other malignant lesions such as metastatic lymph nodes or malignant lymphomas and benign hilar strictures should not be treated surgically.
invasive tissue sampling explorations (Fig. 1) are generally advocated prior to the therapeutic decision in order to choose the adequate treatment.
Methods and materials
Between September 2014 and September 2018,
44 patients (27 male,
mean age 61 years) underwent 45 biliary forceps biopsy procedures,45 transluminal biopsies during percutaneous transhepatic biliary drainage (PTBD) due to obstructive jaundice,
using dedicated transluminal biliary access and biopsy forceps set (Cook Medical,
USA) Fig. 2 .
All patients presented with obstructive jaundice,
suspected malignant (Fig. 3).
Pre-procedural MRCP was performed in all cases ( Fig. 4 ).
The study’s primary efficacy endpoint was technical success and the primary safety endpoint was the procedure-related major...
Tissue sample allowed histological diagnosis in 42/45 procedures (technical success rate 93.3%),
as in 3 cases (6.6%) the sample was characterized non-diagnostic.
In one case,
biopsy was successfully repeated.
The diagnosis was:
• 26 cholangiocarcinoma (57.77%);
• 6 metastasis (13.33%);
• 6 pancreatic adenocarcinoma (13.33%);
• 5 inflammation (11.11%);
• 2 normal tissue (4.93%).
The 6 to 40 months follow-up showed only 4 false negative cases of inflammation (n=2) and normal tissue (n=2) proven to be cholangiocarcinoma (n=2) and metastasis (n=2),
resulting in sensitivity 90.48%,...
Endobiliary Biopsy is a safe and accurate procedure.
Compared to EUS-FNA,
it provides similar sensitivity,
negative predictive value and accuracy.
It should therefore be considered as the preferred tissue-sampling procedure,
if biliary drainage is indicated.
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