title: The Wire-Grasping Method as a New Technique for Forceps Biopsy of Biliary Strictures: A Prospective Randomized Controlled Study of Effectiveness.
abstract: OBJECTIVE
  Transpapillary forceps biopsy is an effective diagnostic technique in patients with biliary stricture. This prospective study aimed to determine the usefulness of the wire-grasping method as a new technique for forceps biopsy.
  
  
  METHODS
  Consecutive patients with biliary stricture or irregularities of the bile duct wall were randomly allocated to either the direct or wire-grasping method group. In the wiregrasping method, forceps in the duodenum grasps a guidewire placed into the bile duct beforehand, and then, the forceps are pushed through the papilla without endoscopic sphincterotomy. In the direct method, forceps are directly pushed into the bile duct alongside a guide-wire. The primary endpoint was the success rate of obtaining specimens suitable for adequate pathological examination.
  
  
  RESULTS
  In total, 32 patients were enrolled, and 28 (14 in each group) were eligible for analysis. The success rate was significantly higher using the wire-grasping method than the direct method (100% vs 50%, p=0.016). Sensitivity and accuracy for the diagnosis of cancer were comparable in patients with the successful procurement of biopsy specimens between the two methods (91% vs 83% and 93% vs 86%, respectively).
  
  
  CONCLUSIONS
  The wire-grasping method is useful for diagnosing patients with biliary stricture or irregularities of the bile duct wall.
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Yamashita
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Ueda
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kawaji
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Tamura
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Itonaga
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Takeichi
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Maeda
authors.affiliation: Department of Internal Medicine, Nokami Kosei General Hospital, Wakayama, Japan.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Magari
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Maekita
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Mikitaka
authors.initials: M
authors.lastname: Iguchi
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Tamai
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Ichinose
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Kato
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery; D001652:Bile Ducts / Q000473:pathology / Q000601:surgery; D001662:Biliary Tract Surgical Procedures / Q000295:instrumentation* / Q000379:methods*; D001706:Biopsy / Q000295:instrumentation / Q000379:methods; D002779:Cholestasis / Q000175:diagnosis* / Q000473:pathology; D003251:Constriction, Pathologic / Q000175:diagnosis; D004386:Duodenum / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013525:Surgical Instruments
keywords: Biliary strictures; Biliary tract; Endoscopic transpapillary biopsy; Sphincterotomy; Surgical instruments