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 20 February 2018

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News

ERCP or EUS for tissue diagnosis of biliary strictures?

Writing in this month's issue of Gastrointestinal Endoscopy, researchers have published the first ever report comparing ERCP and EUS with respect to their accuracy in tissue diagnosis of biliary strictures.

News image

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The present figure for accuracy of ERCP-based brush cytology or forceps biopsy for tissue diagnosis is relatively low, usually not exceeding 70%.

In comparison the reported accuracy rates of EUS-guided FNA of pancreatobiliary masses are higher, at 80%.

In a prospective study, Dr Werner and colleagues compared these two modalities used in diagnosis of indeterminate biliary strictures and pancreatic tumors.

50 consecutive patients (29 men, 21 women; mean age 62.1 years) with obstructive jaundice in whom a tissue diagnosis was required were recruited to take part in the study.

During ERCP, intraductal specimens were obtained with a forceps and with two different types of brush (conventional and spiral suction) in random order.

During EUS, only visible mass lesions or localized bile duct wall thickening were aspirated (22-gauge needle), with at least two passes yielding material sufficient for assessment.

A cytopathologist was not present in the procedure room to evaluate specimen adequacy.

The reference methods used were surgery, other biopsy results, follow-up until death, or the conclusion of the study (mean follow-up 20 months).

The final diagnoses were malignancy, 28 (16 pancreatic, 12 biliary), and benign biliary stricture, 22.

Sensitivity and specificity for ERCP-guided biopsy were 36% and 100%, respectively; while for ERCP-guided cytology (when using conventional and spiral suction brushes) they were 46% and 100%, respectively.

For EUS-guided FNA, sensitivity and specificity were 43% and 100%, respectively.

When the researchers considered punctured lesions alone, the sensitivity of EUS-guided FNA was 75%.

They found that, in general, sensitivity was better for ERCP-based techniques in the subgroup biliary tumor (ERCP 75% vs. EUS 25%), whereas EUS-guided biopsy was superior for pancreatic mass (EUS 60% vs. ERCP 38%).

Commenting on their findings, Dr Werner said, "For biliary strictures, combined ERCP- and EUS-guided tissue acquisition seems to be the best approach to tissue diagnosis."

He added, "From a clinical standpoint, it appears reasonable, when a tissue diagnosis is required, to start with ERCP if biliary malignancy is suspected and with EUS when a pancreatic tumor is thought to be the cause of a biliary stricture."

Gastrointestinal Endoscopy;2004:60(3):
17 September 2004

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