title: Endoscopic ultrasound and fine-needle aspiration of unexplained bile duct strictures.
abstract: OBJECTIVE
  The aim of this study was to assess the utility of endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) in patients with unexplained common bile duct strictures after endoscopic retrograde cholangiopancreatography (ERCP) and intraductal tissue sampling.
  
  
  METHODS
  Records were reviewed for all subjects undergoing EUS for evaluation of unexplained bile duct strictures at our institution. 40 subjects had either a final histologic diagnosis (24) or no evidence of malignancy after at least 1 yr of follow-up (16).
  
  
  RESULTS
  The finding of a pancreatic head mass and/or an irregular bile duct wall had sensitivity for malignancy of 88%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 84%. Bile duct wall thickness >/=3 mm had a sensitivity for malignancy of 79%, specificity of 79%, positive predictive value of 73%, and negative predictive value of 80%. Sensitivity of EUS FNA for malignancy was 47% with specificity 100%, positive predictive value 100%, and negative predictive value 50%.
  
  
  CONCLUSIONS
  Sonographic features may be more sensitive than EUS FNA for diagnosis of unexplained bile duct strictures and include presence of a pancreatic mass, an irregular bile duct wall, or bile duct wall thickness > 3 mm. EUS FNA cytology is specific but insensitive for diagnosis. EUS improves the diagnosis of otherwise unexplained bile duct strictures.
authors.affiliation: Section of Digestive Diseases, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lee
authors.forename: Ronald
authors.initials: R
authors.lastname: Salem
authors.forename: Harry
authors.initials: H
authors.lastname: Aslanian
authors.forename: Mary
authors.initials: M
authors.lastname: Chacho
authors.forename: Mark
authors.initials: M
authors.lastname: Topazian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D001707:Biopsy, Needle / Q000379:methods*; D002779:Cholestasis / Q000000981:diagnostic imaging* / Q000473:pathology*; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors