Endoscopy 2019; 51(04): S37
DOI: 10.1055/s-0039-1681277
ESGE Days 2019 oral presentations
Friday, April 5, 2019 11:00 – 13:00: ERCP stenosis Club H
Georg Thieme Verlag KG Stuttgart · New York

THE ROLE OF “ROSE” FOR ERCP-GUIDED BRUSHING ON INDETERMINATE BILIARY STRICTURES: EXPERIENCE OF A REFERRAL CENTER

L Archibugi
1   Pancreatobiliary and Endosonography Unit, San Raffaele Hospital, Milan, Italy
,
A Mariani
1   Pancreatobiliary and Endosonography Unit, San Raffaele Hospital, Milan, Italy
,
B Ciambriello
2   Digestive Endoscopy, AO Specialistica del Colle CTO, Naples, Italy
,
MC Petrone
1   Pancreatobiliary and Endosonography Unit, San Raffaele Hospital, Milan, Italy
,
G Rossi
1   Pancreatobiliary and Endosonography Unit, San Raffaele Hospital, Milan, Italy
,
SGG Testoni
1   Pancreatobiliary and Endosonography Unit, San Raffaele Hospital, Milan, Italy
,
M Traini
1   Pancreatobiliary and Endosonography Unit, San Raffaele Hospital, Milan, Italy
,
G Capurso
1   Pancreatobiliary and Endosonography Unit, San Raffaele Hospital, Milan, Italy
,
PG Arcidiacono
1   Pancreatobiliary and Endosonography Unit, San Raffaele Hospital, Milan, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Endoscopic Retrograde CholangioPancreatography (ERCP), although nowadays used only for therapeutic purposes, still has a prominent diagnostic role in patients with indeterminate biliary strictures and no evidence of mass lesion. The use of biliary stricture brushing is a safe, easy, cheap and fast way to acquire cytological specimen from the determination of the etiology, but the sensitivity can be as low as 50%. Rapid On-Site Evaluation (ROSE) of the sample has been used for years in referral centers for the determination of the adequacy of EUS-guided FNA cytological specimens, improving its sensitivity and specificity. Nevertheless, there are currently no studies evaluating its role for ERCP brushing. The aim of this study was to assess the diagnostic yield of ERCP brushing of indeterminate biliary strictures when supported by ROSE.

Methods:

Retrospective single-center study enrolling consecutive patients undergoing ERCP and brush cytology supported by ROSE for indeterminate biliary strictures, from January 1st 2010 to May 31st 2018. Data recorded included patient's characteristics, clinical/radiological/EUS features, ERCP features (stricture features, number of brush passages, final cytology or histology when biopsy was performed as an adjunct, cholangioscopy or confocal laser endomicroscopy use, final diagnosis after surgery or follow-up). The diagnostic yield of ERCP-guided brushing with ROSE was then calculated.

Results:

96 patients underwent ERCP for indeterminate biliary stenosis, 50% males, mean age 68.1 years, 80% having an extrahepatic biliary stricture. 90 patients underwent brushing+ROSE and were included in the analysis, with 86.7% of patients having an adequate sample at ROSE. The preliminary diagnostic yield calculated showed sensitivity = 80%, specificity = 82%, accuracy = 81%, positive predictive value = 92% and negative predictive value = 61%.

Conclusions:

The availability of ROSE in patients undergoing ERCP with indeterminate biliary stricture without a mass lesion increases the diagnostic yield of brushing, decreasing the need of further procedures, such as cholangioscopy and confocal laser endomicroscopy and can, therefore, decrease costs and increase safety.