Improving the use of ERCP for investigating biliary strictures

A study in the most recent issue of Endoscopy assesses intraductal optical coherence tomography during endoscopic retrograde cholangiopancreatography for investigation of biliary strictures.

Optical coherence tomography uses infrared light reflectance to produce high-resolution cross-sectional tissue images.

Dr Arvanitakis and colleagues from Belgium demonstrated the feasibility of biliary intraductal coherence tomography during endoscopic retrograde cholangiopancreatography (ERCP).

The team also assessed the potential of the method to detect malignant biliary strictures.

The team studied 37 patients with biliary strictures during therapeutic endoscopic retrograde cholangiopancreatography.

Malignant strictures were defined as those that demonstrated malignant cells in brushing and/or biopsy specimens, and/or endoscopic ultrasound-guided fine-needle aspiration and/or surgery.

Malignancy was confirmed by biliary biopsies in 63%

Endoscopy

Strictures that did not have malignant cells in resected specimens and were without clinical/radiological evidence of disease progression for at least a 12-month follow-up period were considered as benign.

The team considered 2 coherence tomography criteria for malignancy were considered, including unrecognizable layer architecture, and presence of large, nonreflective areas compatible with tumor vessels.

Sensitivity and specificity for brushings/biopsies as well as coherence tomography criteria were calculated.

The researchers found that 19 patients had malignant and 16 had benign strictures.

In 2 patients, coherence tomography assessment could not be performed due to tight strictures.

Malignancy was confirmed by biliary brushings/biopsies in 63% of patients.

Coherence tomography revealed that 2 malignancy criteria were encountered in 53%, and at least 1 criterion in 79% of patients with malignant strictures.

No patient with benign stricture met both criteria, and 31% met 1 criterion.

Combining brushings/biopsy with the observation of at least one coherence tomography criterion resulted in the diagnosis of malignancy in 84% of patients.

Dr Arvanitakis's team concluded, “Coherence tomography may improve the sensitivity and diagnostic accuracy of biliary brushings/biopsies alone.”