title: Diagnosing Biliary Malignancy.
abstract: The most common malignant causes of biliary strictures are pancreatic cancer and cholangiocarcinoma. Differentiating between malignant and benign causes of biliary strictures has remained a clinical challenge. Endoscopic retrograde cholangiopancreatography (ERCP) remains the mainstay and first-line method of tissue diagnosis but has a poor diagnostic yield. This article reviews the causes of biliary strictures, the initial clinical evaluation of biliary obstruction, the diagnostic yield of ERCP-based sampling methods, the role of newer tools in the armamentarium for evaluating strictures, and ways to address the ongoing challenge of stricture evaluation in patients with primary sclerosing cholangitis.
authors.affiliation: Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY, USA.
authors.forename: Ming-ming
authors.initials: MM
authors.lastname: Xu
authors.affiliation: Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY, USA. Electronic address: amrita72@hotmail.com.
authors.forename: Amrita
authors.initials: A
authors.lastname: Sethi
mesh_terms: D001659:Biliary Tract / Q000473:pathology; D001661:Biliary Tract Neoplasms / Q000175:diagnosis* / Q000209:etiology; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods* / Q000706:statistics & numerical data; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000601:surgery; D002779:Cholestasis / Q000175:diagnosis* / Q000473:pathology; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D012680:Sensitivity and Specificity
keywords: Cholangiocarcinoma (CCA); Endoscopic ultrasonography (EUS); Fluorescence in situ hybridization (FISH); Indeterminate biliary stricture; Intraductal ultrasonography (IDUS); Pancreatic cancer; Primary sclerosing cholangitis (PSC); Probe-based confocal endomicroscopy (pCLE)