title: Evaluation of hilar biliary strictures by using a newly developed forward-viewing therapeutic echoendoscope: preliminary results of an ongoing experience.
abstract: BACKGROUND
  Obtaining a definitive tissue diagnosis in patients with hilar biliary strictures (HBS) is often difficult.
  
  
  OBJECTIVE
  To describe our experience using a newly developed forward-viewing linear echoendoscope (FVL-EUS) with FNA as a primary diagnostic tool in patients with HBS.
  
  
  METHODS
  Case series.
  
  
  METHODS
  A tertiary care, academic medical center.
  
  
  METHODS
  Four patients with HBS who underwent the procedure.
  
  
  METHODS
  Performance of FNA with the FVL-EUS.
  
  
  RESULTS
  Visualization and puncture of the primary lesion with a definitive tissue diagnosis was obtained in all of the 4 cases performed. Metastatic hilar cholangiocarcinoma and recurrent neuroendocrine tumor were diagnosed in 2 patients and followed by placement of a self-expandable metal stent, when possible. In the other 2 patients, a diagnosis of resectable hilar cholangiocarcinoma and poorly differentiated adenocarcinoma of unclear origin without evidence of vascular involvement was made, and plastic stents were placed before surgery; the first patient was found to have peritoneal metastases, and resection was aborted, and in the second patient, a gallbladder tumor was diagnosed in the surgical specimen.
  
  
  CONCLUSIONS
  The small number of patients.
  
  
  CONCLUSIONS
  These preliminary data suggest that FVL-EUS used as a primary tool for the evaluation of patients with HBS may be of value and should be further explored in properly designed studies with a meaningful number of patients.
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Larghi
authors.forename: Piera Giuseppina
authors.initials: PG
authors.lastname: Lecca
authors.forename: Francesco
authors.initials: F
authors.lastname: Ardito
authors.forename: Esther Diana
authors.initials: ED
authors.lastname: Rossi
authors.forename: Guido
authors.initials: G
authors.lastname: Fadda
authors.forename: Gennaro
authors.initials: G
authors.lastname: Nuzzo
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis; D000368:Aged; D001650:Bile Duct Neoplasms / Q000175:diagnosis; D001653:Bile Ducts, Intrahepatic; D044963:Biopsy, Fine-Needle; D018281:Cholangiocarcinoma / Q000175:diagnosis; D002780:Cholestasis, Intrahepatic / Q000175:diagnosis*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents