title: Combined brush cytology and stent placement in a single session for presumed malignant biliary stricture.
abstract: OBJECTIVE
  Biliary stricture may be benign or malignant and causes obstructive jaundice. Brush cytology is a simple technique for diagnosing the cause of biliary stricture; however, its sensitivity has been reported to be low. A technique that comprises diagnosing the cause of stricture with a satisfactory sensitivity and relieving jaundice is required. This study was designed to evaluate the diagnostic performance of brush cytology and the feasibility of the subsequent stent placement in a single endoscopic retrograde cholangiopancreatography (ERCP) session performed for presumed malignant biliary strictures.
  
  
  METHODS
  Data were collected by reviewing the medical records of 100 consecutive patients with suspected malignant biliary stricture who underwent brush cytology followed by stent placement at our center. Diagnostic performance of brush cytology, completion rate of the whole procedures comprising brush cytology and stent placement, and complications were evaluated.
  
  
  RESULTS
  Sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of brush cytology were 83%, 100%, 100%, 33% and 84%, respectively. Biliary stent was successfully inserted for all patients (100%) subsequent to brush cytology in a single ERCP session. Eight patients (8%) had complications.
  
  
  CONCLUSIONS
  Brush cytology was performed with much higher sensitivity of 83% than those of previous reports and the subsequent stent placement was successfully completed in all cases. For presumed malignant biliary stricture, brush cytology should be selected as an initial attempt because this technique is simple and enables subsequent stent placement in a single ERCP session.
authors: Department of Gastroenterology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari, Osaka, Japan.
authors: Natsuko
authors: N
authors: Kawada
authors: Hiroyuki
authors: H
authors: Uehara
authors: Kazuhiro
authors: K
authors: Katayama
authors: Yasuna
authors: Y
authors: Takano
authors: Rena
authors: R
authors: Takakura
authors: Kazuho
authors: K
authors: Imanaka
authors: Kazuyoshi
authors: K
authors: Ohkawa
authors: Akemi
authors: A
authors: Takenaka
authors: Osamu
authors: O
authors: Ishikawa
mesh_terms: D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation*; D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D003251:Constriction, Pathologic; D003581:Cytodiagnosis / Q000295:instrumentation; D004067:Digestive System Neoplasms / Q000150:complications / Q000175:diagnosis*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007564:Japan; D041781:Jaundice, Obstructive / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015607:Stents; D016896:Treatment Outcome