Original ArticlesTriple-tissue sampling at ERCP in malignant biliary obstruction☆
Section snippets
PATIENTS AND METHODS
From 1991 to 1995, selected (nonconsecutive) patients with biliary obstruction presenting to the ERCP service of our medical center with jaundice, in whom there was clinical suspicion of malignancy but without histologic confirmation from other sources, underwent simultaneous tissue sampling by brushing, forceps biopsy, and fine-needle aspiration cytology at one ERCP session. We consider tissue sampling part of the standard of care when a biliary stricture is encountered at ERCP. Approval for
RESULTS
A total of 137 patients were evaluated by triple-tissue sampling. However, four patients were excluded due to lack of adequate follow-up and no histopathologic evidence of malignancy. One-hundred thirty-three patients were therefore available for analysis, of which 104 had cancer and 29 had benign disease based on the above criteria. Forty-six patients had pancreatic cancer, 30 had cholangiocarcinoma, 13 had ampullary carcinoma, and 15 had metastatic cancer. Among patients with metastases, the
DISCUSSION
Aspiration of bile or pancreatic juice is the easiest method of obtaining cellular material when evaluating biliary strictures for malignancy. Unfortunately, the results have been largely disappointing, with cancer sensitivities in the 6% to 32% range1, 7, 11, 12 and frequent acellular specimens. The desmoplastic nature of certain tumors or failure of the neoplasm to invade the ductal epithelium is likely responsible for these results.13 It has been suggested that endoscopic manipulation of the
References (23)
- et al.
Endoscopic retrograde forceps biopsy and brush cytology of biliary strictures: a prospective study
Gastrointest Endosc
(1995) - 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) - et al.
Comparison of flow cytometry for DNA content and brush cytology for detection of malignancy in pancreatobiliary strictures
Gastrointest Endosc
(1994) - et al.
Brush cytology during ERCP for the diagnosis of biliary and pancreatic malignancies
Gastrointest Endosc
(1994) - et al.
Endoscopic retrograde brush cytology: a new technique
Gastroenterology
(1990) - et al.
Endoscopic sphincterotomy complications and their management: an attempt at consensus
Gastrointest Endosc
(1991) - et al.
Diagnosis of malignant obstructive jaundice by bile cytology: results improved by dilating the bile duct stricture
Gastrointest Endosc
(1994) - et al.
Endoscopic needle aspiration biopsy at ERCP in the diagnosis of biliary strictures
Gastrointest Endosc
(1992) - et al.
Endoscopic scraping biopsy of malignant biliary strictures
Gastrointest Endosc
(1989) - et al.
Complete tissue sampling of biliary strictures at ERCP using a new device
Gastrointest Endosc
(1996)
Analysis of Ki-ras codon 12 mutations in the duodenal juice of patients with pancreatic cancer
Gastroenterology
Cited by (0)
- ☆
Reprint requests: Evan Fogel, MD, Division of Gastroenterology and Hepatology, Indiana University Hospital, 550 N. University Blvd., Suite 2300, Indianapolis, IN 46202.