title: Endoductal tissue sampling of biliary strictures through endoscopic retrograde cholangiopan creatography (ERCP).
abstract: OBJECTIVE
  Pathological proof of malignant in biliary strictures is useful in the preoperative setting as it helps define therapeutic planning and prognosis, and reduces the length of the subsequent surgical intervention. However, it is difficult to obtain. The aim of this study was to evaluate the yield of histological and cytological examination of endobiliary samples obtained during endoscopic retrograde cholangiopancreatography (ERCP).
  
  
  METHODS
  Endobiliary forceps biopsy and brush cytology were performed during ERCP examination in 52 consecutive patients, 36 with malignant and 16 with benign strictures.
  
  
  RESULTS
  Histology and cytology turned out to have the same sensitivity (53%). The gain in sensitivity achieved by combining the two techniques was limited, reaching a value of 61%. The specificity, however, was 100% for both methods. Most of the few complications observed were due to sphincterotomy and subsided spontaneously or with medical treatment. However, one patient experienced a serous complication and chose to be treated by surgical intervention. The complication was caused by forceps biopsy.
  
  
  CONCLUSIONS
  This study shows that 1) sampling of biliary strictures during ERCP is the primary approach to tissue diagnosis; 2) brush cytology alone is sufficient in clinical practice; 3) forceps biopsy must always be used to sample intra-ampullary strictures but should be considered as a secondary step to sample strictures located more proximally, in the bile ducta, if previous cytology was negative.
authors.affiliation: Dipartimento di Oncologia, Università degli Studi, Genova, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Pugliese
authors.forename: G
authors.initials: G
authors.lastname: Antonelli
authors.forename: M
authors.initials: M
authors.lastname: Vincenti
authors.forename: B
authors.initials: B
authors.lastname: Gatteschi
mesh_terms: D001659:Biliary Tract / Q000000981:diagnostic imaging / Q000473:pathology*; D001661:Biliary Tract Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D001706:Biopsy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003251:Constriction, Pathologic; D006801:Humans; D012680:Sensitivity and Specificity