ERCP-Guided Tissue Acquisition In Intrinsic Biliary Strictures: Still A Long Way To Go!

Aims Endoscopic retrograde cholangiopancreatography (ERCP) is essential in the workup of intrinsic bile duct strictures, allowing both tissue sampling and drainage of the bile duct. However, the diagnostic yield of ERCP in this setting is suboptimal. We aimed to evaluate the yield of ERCP-guided tissue acquisition in distinct clinical scenarios according to the pre-test probability of malignancy.

Methods We conducted a retrospective, single tertiary center study of patients that underwent ERCP procedures with tissue acquisition in the setting of intrinsic bile duct strictures of unknown etiology. We collected clinical data and used the cross-sectional imaging of the lesions prior to ERCP to classify patients as high probability (visible mass, suspicious nodes or metastases) or low probability of malignancy (none of the above). A final diagnosis of malignancy was established based on pathology reports from endoscopy or surgery or based on clinical evolution at 6 months follow-up.

Results We included 55 procedures in 39 patients with intrinsic bile duct strictures. Based on initial imaging, 34 (61.8 %) cases were classified as highly suspicious of malignancy and 21 cases were classified as low risk. ERCP-guided tissue acquisition was performed via X-ray guided biopsy (25), brushing (23), cholangioscopy-guided (3) or a combination of methods (4). Only 20 (36.4 %) of the samples were confirmed as malignant, although a diagnosis of malignancy was ultimately established in 50 patients (90.9 %). There was no significant difference in diagnostic yield with respect to pre-procedural imaging data (high versus low probability, p=0.77), type of stricture (proximal vs distal, p=0.55), preprocedural bilirubin levels (p=0.93) or type of tissue acquisition method used.

Conclusions The sensitivity of ERCP-guided tissue acquisition remains suboptimal for confirming malignancy in a cancer-rich patient population, irrespective of clinical, biochemical and imaging predictors. Alternative diagnostic strategies beyond intraductal tissue sampling should be explored in this patient population.

Citation Puscasu CI, Voiosu T, Stoian G et al. eP328 ERCP-GUIDED TISSUE ACQUISITION IN INTRINSIC BILIARY STRICTURES: STILL A LONG WAY TO GO!.Endoscopy 2021; 53: S205.

Publication History

Article published online:
19 March 2021