title: Performance of bile aspiration plus brushing to diagnose malignant biliary strictures during endoscopic retrograde cholangiopancreatography.
abstract: OBJECTIVE
  Endobiliary brushing during endoscopic retrograde cholangiopancreatography (ERCP) is the main technique used to diagnose a malignant stricture, but has a poor sensitivity. This study evaluated the diagnostic performance of bile aspiration associated with biliary brushing during ERCP to diagnose a malignant stricture, compared to brushing alone.
  
  
  METHODS
  Between January 2007 and December 2012, all consecutive patients undergoing ERCP to treat a biliary stricture were included. After a biliary sphincterotomy, 3 mL to 10 mL of bile was aspirated into the brush catheter and collected in a dry sterile tube before and after brushing (to yield three samples). Brushing was performed as commonly recommended.
  
  
  RESULTS
  One hundred eleven patients (68 males, 43 females) were included; mean age 67 ± 15.4 years. A final diagnosis of malignant stricture was established in 51 patients, including 43 cholangiocarcinomas; 60 patients had benign strictures. Specificity (Sp) and positive predictive values were 100% for all samples. The diagnostic performance of the three-sample combination of bile aspiration + brushing + bile aspiration was significantly greater than brushing alone (P = 0.004): sensitivity (Se) = 84.3 % vs. Se = 66.7 %. The three-sample combination gave a negative predictive value of 88.2 %, and a diagnostic accuracy of 92.8 %. When suspicious results were added to malignant results as positive results, the three-sample combination gave Sp = 91.7 % and Se = 94.1 %.
  
  
  CONCLUSIONS
  In cases of biliary stricture, conducting bile aspiration before and after brushing significantly increased the ability to diagnose a malignant stricture with a sensitivity of 84.3 % (P = 0.004).
authors.affiliation: Clinique Universitaire d'Hépato-gastroentérologie, Pôle Digidune, CHU Grenoble, Alpes; INSERM U1209, Grenoble, France; Faculté de Médecine, Université Grenoble Alpes, Grenoble, France.
authors.forename: Gael S
authors.initials: GS
authors.lastname: Roth
authors.affiliation: Clinique Universitaire d'Hépato-gastroentérologie, Pôle Digidune, CHU Grenoble, Alpes.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bichard
authors.affiliation: Clinique Universitaire de Cytologie et Pathologie, Pôle Biologie et Pathologie, CHU Grenoble, Alpes.
authors.forename: Michele
authors.initials: M
authors.lastname: Fior-Gozlan
authors.affiliation: Pôle Recherche, CHU Grenoble, Alpes; Centre de Recherche en Nutrition Humaine Rhône-Alpes, Lyon, France; Inserm U1055-Bioénergétique, Université Grenoble Alpes, France.
authors.forename: Hubert
authors.initials: H
authors.lastname: Roth
authors.affiliation: Clinique Universitaire d'Hépato-gastroentérologie, Pôle Digidune, CHU Grenoble, Alpes.
authors.forename: Jean
authors.initials: J
authors.lastname: Auroux
authors.affiliation: Clinique Universitaire de chirurgie digestive, Pôle Digidune, CHU Grenoble, Alpes.
authors.forename: Olivier
authors.initials: O
authors.lastname: Risse
authors.affiliation: INSERM U1209, Grenoble, France; Faculté de Médecine, Université Grenoble Alpes, Grenoble, France; Clinique Universitaire de chirurgie digestive, Pôle Digidune, CHU Grenoble, Alpes.
authors.forename: Christian
authors.initials: C
authors.lastname: Letoublon
authors.affiliation: Clinique Universitaire de Cytologie et Pathologie, Pôle Biologie et Pathologie, CHU Grenoble, Alpes.
authors.forename: Marie Hélène
authors.initials: MH
authors.lastname: Laverrière
authors.affiliation: Faculté de Médecine, Université Grenoble Alpes, Grenoble, France; Clinique Universitaire de Radiologie et Imagerie Médicale, Pôle Imagerie, CHU Grenoble, Alpes.
authors.forename: Ivan
authors.initials: I
authors.lastname: Bricault
authors.affiliation: Clinique Universitaire d'Hépato-gastroentérologie, Pôle Digidune, CHU Grenoble, Alpes; INSERM U1209, Grenoble, France; Faculté de Médecine, Université Grenoble Alpes, Grenoble, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Leroy
authors.affiliation: Clinique Universitaire d'Hépato-gastroentérologie, Pôle Digidune, CHU Grenoble, Alpes; INSERM U1209, Grenoble, France; Faculté de Médecine, Université Grenoble Alpes, Grenoble, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Decaens