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Clinical utility of EUS before cholangioscopy in the evaluation of difficult biliary strictures.

Abstract：

BACKGROUND:Biliary tract malignancies can be assessed with either EUS or SpyGlass cholangioscopy (SGC). OBJECTIVE:To evaluate the impact of EUS and guided biopsy before considering SGC in patients who had biliary strictures with negative ductal brushing. DESIGN:Prospective, observational study. SETTING:Tertiary level referral hospital. PATIENTS:Forty consecutive patients with biliary strictures. INTERVENTION:EUS evaluation and biopsy, where possible, were performed in all patients. If EUS examination failed to provide a definitive diagnosis, SGC and ductal biopsy was performed. Results were compared with surgical specimens or positive histocytology. MAIN OUTCOME MEASUREMENTS:Tissue diagnosis, technical success, adverse events, and clinical outcomes. RESULTS:On EUS, abnormalities responsible for the biliary strictures were identified in 39 patients (98%), with FNA achievable in 30 patients (75%). EUS-FNA provided positive histocytology in 23 patients (58%). SGC-guided biopsy was performed to evaluate nondiagnostic EUS-FNA (17 patients) and to clarify autoimmune pancreatitis on FNA (2 patients). The procedure was successful in 18 patients (95%) and provided tissue diagnosis in 16 patients (88%), with 2 false-negative results from extrinsic pathologies. When EUS was used before the SGC approach, the need for SGC was avoided in 24 patients (60%), cholangitis was minimized in 2.5%, and a cost saving of U.S.$110,000 was realized. Tissue diagnosis was achieved in 38 patients (94%) with this approach. LIMITATIONS:Relatively small sample size. CONCLUSIONS:EUS evaluation in patients with difficult biliary stricture prevents the need, cost, and adverse events of SGC in 60% of patients. Together, EUS followed by the SGC approach provides correct clinical diagnosis in 94% of patients with minimal adverse events.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Nguyen NQ,Schoeman MN,Ruszkiewicz A

doi

10.1016/j.gie.2013.05.020

subject

Has Abstract

pub_date

2013-12-01 00:00:00

pages

868-874

issue

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(13)01979-2

journal_volume

pub_type

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Clinical utility of EUS before cholangioscopy in the evaluation of difficult biliary strictures.