ERCP TISSUE SAMPLING FROM COMMON BILE DUCT STRICTURES: BRUSH CITOLOGY AND INTRADUCTAL FORCEPS BIOPSY – WHICH ONE SHOULD I PERFORM FIRST?

Introduction:

The accuracy of brush citology (BC) plus intraductal forceps biopsy (IFB) in diagnosis of common bile duct strictures (CBDs) is about 60%. It is unknown whether the order of perform both methods improves accuracy.

Objective:

To compare the accuracy of BC plus IFB sampling in diagnosis of CBDs regarding the order of perform both.

Main outcome measures:

Accuracy of BC plus IFB sampling from CBDs.

Secondary outcomes measures:

Sensitivity, specificity and accuracy of BC and IFB separately and combined.

Method:

Open label randomized controlled trial.

Participants:

Patients with CBDs.

Intervention:

We randomly assigned patients to BC plus IFB or IFB plus BC sampling from CBDs.

Results:

We included 130 patients. Age: 72.5 ± 13.84y; 54.6% men. The 63.1% of CBDs were malignant (48.8% pancreatic tumours, 48.8% cholangiocarcinomas and 0.2% others). The diagnostic accuracy, defined as the confirmation of the initial diagnosis during a follow- up by 6 months, reached 95.8% in benign strictures and 79.3% in malignant. Take ≥3 tissue samples increases accuracy in 7% respect take < 3. Separately BC reached a 75,4% and IFB, 76.9%, which rose up to 85.4% in combination. There was not difference according to the order of method perform: BC plus IFB was 82,4% and IFB plus BC was 88,7%, p = n.s.

The specificity and PPV of BC and IFB was 100% while the sensitivity was 62.7% with BC; and 63.7% IFB, which increase until 78% when both methods were combined.

Conclusions:

The order of perform brush citology plus intraductal forceps biopsy does not change the diagnostic accuracy in common bile duct strictures.

The diagnostic accuracy and sensitivity substantially increase when both methods are combined and ≥3 tissue samples are taken.