Abstract
Background: Brush cytology, routinely performed at ERCP to assess malignant-appearing biliary
strictures, is limited by relatively low sensitivity and negative predictive value.
This study assessed whether the combination of stricture dilation, endoscopic needle
aspiration, and biliary brushing improves diagnostic yield. Methods: In a prospective nonrandomized study, 46 consecutive patients were evaluated with
malignant-appearing biliary strictures at ERCP. Twenty-four patients (Group A) underwent
standard brush cytology alone and 22 patients (Group B) underwent stricture dilatation
to 10F, endoscopic needle aspiration, and subsequent biliary brushing by using the
Howell biliary system. The diagnostic yields for both techniques were compared. Results: Of the 46 patients, 34 had proven malignant strictures (14 Group A, 20 Group B).
Compared with brushing alone, the combination of stricture dilatation, endoscopic
needle aspiration, and subsequent biliary brushing significantly increased both the
sensitivity (57% vs. 85%, p < 0.02) and specificity (80% vs. 100%, p < 0.02) of cytology with positive brushings in all patients with pancreatic or gallbladder
carcinoma. Conclusions: The combination of stricture dilation, endoscopic needle aspiration, and biliary
brushing significantly improves diagnostic yield for malignant bile duct strictures
and may particularly be of benefit for extrinsic strictures caused by pancreatic or
gallbladder carcinoma. (Gastrointest Endosc 2001;54:587-94.)
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Article info
Publication history
Accepted:
July 13,
2001
Received in revised form:
November 29,
2000
Received:
October 3,
2000
Footnotes
☆Ajay K. Jain was supported by an educational grant from Hargobind Foundation, India.
☆☆Reprint requests: Douglas K. Pleskow, MD, Suite 8E, Lowry Bldg., 110 Francis St., Beth Israel Deaconess Medical Center, Boston, MA 02215.
Identification
Copyright
© 2001 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
