title: Usefulness of endoscopic retrograde biliary biopsy using large-capacity forceps for extrahepatic biliary strictures: a prospective randomized study.
abstract: OBJECTIVE
  Endoscopic retrograde biliary biopsy samples are frequently too small and inadequate, which makes histological interpretation difficult. We therefore evaluated the diagnostic usefulness of forceps with a larger-sized cup and compared this with standard forceps for biliary biopsy.
  
  
  METHODS
  This prospective study included consecutive patients with extrahepatic biliary strictures who underwent retrograde biliary biopsy between March 2005 and March 2006 at the Toho University Ohashi Medical Center. The standard forceps used were 1.8-mm forceps (FB-39Q, Olympus, Tokyo, Japan) and the large-capacity forceps were 2.2-mm forceps (Radial jaw3, Boston Scientific Inc., Natick, Massachusetts, USA). Four randomized biopsy specimens were taken from each patient, two using each type of forceps.
  
  
  RESULTS
  A total of 32 patients (30 with malignant biliary strictures and 2 with benign biliary strictures) were enrolled. The median size of the biopsy samples taken using the standard forceps was 0.68 mm (2) and that using the large-capacity forceps was 1.98 mm (2) ( P < 0.0001). Significant differences between the standard forceps and large-capacity forceps were observed in sensitivity (43 % vs. 70 %), adequacy of the specimens, and submucosal tissue sampling rate.
  
  
  CONCLUSIONS
  Large-capacity forceps performed better than standard forceps in terms of size, adequacy of the sample, submucosal sampling rate, and detection of neoplasia.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi Meguro-ku, Tokyo, Japan. masaki@seirei-numazu.com
authors.forename: M
authors.initials: M
authors.lastname: Ikeda
authors.forename: I
authors.initials: I
authors.lastname: Maetani
authors.forename: K
authors.initials: K
authors.lastname: Terada
authors.forename: T
authors.initials: T
authors.lastname: Ukita
authors.forename: T
authors.initials: T
authors.lastname: Tada
authors.forename: H
authors.initials: H
authors.lastname: Shigoka
authors.forename: S
authors.initials: S
authors.lastname: Omuta
authors.forename: K
authors.initials: K
authors.lastname: Takahashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017734:Bile Ducts, Extrahepatic / Q000473:pathology*; D001706:Biopsy / Q000295:instrumentation*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation* / Q000379:methods*; D001651:Cholestasis, Extrahepatic / Q000473:pathology*; D004067:Digestive System Neoplasms / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000473:pathology; D011446:Prospective Studies; D018709:Statistics, Nonparametric