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ERCP for Biliary-Pancreatic Tissue Acquisition

  • Wen-Hsin HuangEmail author
Chapter

Abstract

Tissue acquisition for endoscopic retrograde cholangiopancreatography (ERCP) is the key step in the assessment of patients with indeterminate biliary strictures. Patients with biliary strictures are characterized by clinical presentation, laboratory testing, imaging studies, and pathological results. Tissue sampling and pathological confirmation at ERCP are essential for patients with malignant biliary strictures who are considered for aggressive surgical management or are candidates for chemotherapy and/or radiation therapy. There are several tissue sampling methods at ERCP including mucosal brushing and transmucosal fine needle aspiration for cytologic examination and mucosal biopsies using a variety of equipments for histological analysis [1]. However, the pathological results of tissue acquisition remain dissatisfied [2]. Many factors causing low diagnostic rate are elucidated, including scirrhous nature of the tumors, low sample sizes acquired, and difficulty in target lesion. Several improved methods and modalities are studied to improve its accuracy, including direct visualization cholangiopancreatoscopy-assisted methods.

Keywords

Tissue acquisition Brush cytology Cytology brush Sampling techniques Forceps biopsy Forceps Intraductal fine needle aspiration Cholangiopancreatoscopy Cholangioscopy Pancreatoscopy SpyGlass SpyBite 

References

  1. 1.
    De Bellis M, Sherman S, Fogel EL, et al. Tissue sampling at ERCP in suspected malignant biliary strictures (Part 2). Gastrointest Endosc. 2002;56:720–30.CrossRefPubMedGoogle Scholar
  2. 2.
    Burnett AS, Calvert TJ, Chokshi RJ. Sensitivity of endoscopic retrograde cholangiopancreatography standard cytology: 10-y review of the literature. J Surg Res. 2013;184:304–11.CrossRefPubMedGoogle Scholar
  3. 3.
    Ponchon T, Gagnon P, Berger F, et al. Value of endobiliary brush cytology and biopsies for the diagnosis of malignant bile duct stenosis: results of a prospective study. Gastrointest Endosc. 1995;42:565–72.CrossRefPubMedGoogle Scholar
  4. 4.
    Lee JG, Leung JW, Baillie J, et al. Benign, dysplastic, or malignant--making sense of endoscopic bile duct brush cytology: results in 149 consecutive patients. Am J Gastroenterol. 1995;90:722–6.PubMedGoogle Scholar
  5. 5.
    Jailwala J, Fogel EL, Sherman S, et al. Triple-tissue sampling at ERCP in malignant biliary obstruction. Gastrointest Endosc. 2000;51:383–90.CrossRefPubMedGoogle Scholar
  6. 6.
    Ornellas LC, Santos Gda C, Nakao FS, et al. Comparison between endoscopic brush cytology performed before and after biliary stricture dilation for cancer detection. Arq Gastroenterol. 2006;43:20–3.CrossRefPubMedGoogle Scholar
  7. 7.
    Weber A, von Weyhern C, Fend F, et al. Endoscopic transpapillary brush cytology and forceps biopsy in patients with hilar cholangiocarcinoma. World J Gastroenterol. 2008;14:1097–101.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Fogel EL, deBellis M, McHenry L, et al. Effectiveness of a new long cytology brush in the evaluation of malignant biliary obstruction: a prospective study. Gastrointest Endosc. 2006;63:71–7.CrossRefPubMedGoogle Scholar
  9. 9.
    De Bellis M, Sherman S, Fogel EL, et al. Tissue sampling at ERCP in suspected malignant biliary strictures (Part 1). Gastrointest Endosc. 2002;56:552–61.CrossRefPubMedGoogle Scholar
  10. 10.
    Navaneethan U, Njei B, Lourdusamy V, et al. Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis. Gastrointest Endosc. 2015;81:168–76.CrossRefPubMedGoogle Scholar
  11. 11.
    Suzuki R, Thosani N, Annangi S, et al. Diagnostic yield of endoscopic cholangiopancreatography-based cytology for distinguishing malignant and benign intraductal papillary mucinous neoplasm: systemic review and meta-analysis. Dig Endosc. 2014;26:586–93.CrossRefPubMedGoogle Scholar
  12. 12.
    Barkun A, Liu J, Carpenter S, et al. Update on endoscopic tissue sampling devices. Gastrointest Endosc. 2006;63:741–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Foutch PG, Harlan JR, Kerr D, et al. Wire-guided brush cytology: a new endoscopic method for diagnosis of bile duct cancer. Gastrointest Endosc. 1989;35:243–7.CrossRefPubMedGoogle Scholar
  14. 14.
    de Bellis M, Fogel EL, Sherman S, et al. Influence of stricture dilation and repeat brushing on the cancer detection rate of brush cytology in the evaluation of malignant biliary obstruction. Gastrointest Endosc. 2003;58:176–82.CrossRefPubMedGoogle Scholar
  15. 15.
    Schoefl R, Haefner M, Wrba F, et al. Forceps biopsy and brush cytology during endoscopic retrograde cholangiopancreatography for the diagnosis of biliary stenoses. Scand J Gastroenterol. 1997;32:363–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Yang R, Naritoku W, Laine L. Prospective, randomized comparison of disposable and reusable biopsy forceps in gastrointestinal endoscopy. Gastrointest Endosc. 1994;40:671–4.CrossRefPubMedGoogle Scholar
  17. 17.
    Woods KL, Anand BS, Cole RA, et al. Influence of endoscopic biopsy forceps characteristics on tissue specimens: results of a prospective randomized study. Gastrointest Endosc. 1999;49:177–83.CrossRefPubMedGoogle Scholar
  18. 18.
    Lin LF, Siauw CP, Ho KS, et al. Guidewire technique for endoscopic transpapillary procurement of bile duct biopsy specimens without endoscopic sphincterotomy. Gastrointest Endosc. 2003;58:272–4.CrossRefPubMedGoogle Scholar
  19. 19.
    Aabakken L, Karesen R, Serck-Hanssen A, et al. Transpapillary biopsies and brush cytology from the common bile duct. Endoscopy. 1986;18:49–51.CrossRefPubMedGoogle Scholar
  20. 20.
    Rustgi AK, Kelsey PB, Guelrud M, et al. Malignant tumors of the bile ducts: diagnosis by biopsy during endoscopic cannulation. Gastrointest Endosc. 1989;3:248–51.CrossRefGoogle Scholar
  21. 21.
    Barkun A, Liu J, Carpenter S, et al. Biliary and pancreatic sampling devices during ERCP. Gastrointest Endosc. 1996;43:775–8.Google Scholar
  22. 22.
    Howell DA, Beveridge RP, Bosco J, et al. Endoscopic needle aspiration biopsy at ERCP in the diagnosis of biliary strictures. Gastrointest Endosc. 1992;38:531–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Fukuda Y, Tsuyuguchi T, Sakai Y, et al. Diagnostic utility of peroral cholangioscopy for various bile duct lesions. Gastrointest Endosc. 2005;62:374–82.CrossRefPubMedGoogle Scholar
  24. 24.
    Shah RJ, Langer DA, Antillon MR, et al. Cholangioscopy and cholangioscopic forceps biopsy in patients with indeterminate pancreaticobiliary pathology. Clin Gastroenterol Hepatol. 2006;4:219–25.CrossRefPubMedGoogle Scholar
  25. 25.
    Moon JH, Terheggen G, Choi HJ, et al. Peroral cholangioscopy: diagnostic and therapeutic applications. Gastroenterology. 2013;144:276–82.CrossRefPubMedGoogle Scholar
  26. 26.
    Draganov PV, Chauhan S, Wagh MS, et al. Diagnostic accuracy of conventional and cholangioscopy-guided sampling of indeterminate biliary lesions at the time of ERCP: a prospective, long-term follow-up study. Gastrointest Endosc. 2012;75:347–53.CrossRefPubMedGoogle Scholar
  27. 27.
    Sun X, Zhou Z, Tian J, et al. Is single-operator peroral cholangioscopy a useful tool for the diagnosis of indeterminate biliary lesion? A systematic review and meta-analysis. Gastrointest Endosc. 2015;82:79–87.CrossRefPubMedGoogle Scholar
  28. 28.
    Navaneethan U, Hasan MK, Kommaraju K, et al. Digital single-operator cholangiopancreatoscopy in the diagnosis and management of pancreatobiliary disorders: a multicenter clinical experience (with video). Gastrointest Endosc. 2016;84:649–55.CrossRefPubMedGoogle Scholar
  29. 29.
    Ryan ME, Baldauf MC. Comparison of flow cytometry for DNA content and brush cytology for detection of malignancy in pancreaticobiliary strictures. Gastrointest Endosc. 1994;40:133–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Baron TH, Harewood GC, Rumalla A, et al. A prospective comparison of digital image analysis and routine cytology for the identification of malignancy in biliary tract strictures. Clin Gastroenterol Hepatol. 2004;2:214–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Burnett AS, Bailey J, Oliver JB, et al. Sensitivity of alternative testing for pancreaticobiliary cancer: a 10-y review of the literature. J Surg Res. 2014;190:535–47.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.College of MedicineChina Medical UniversityTaichungTaiwan
  2. 2.Division of Hepatogastroenterology, Department of Internal MedicineChina Medical University HospitalTaichungTaiwan

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