Abstract
The diagnostic approach to the biliary tree disorders can be challenging, especially for biliary strictures. Albeit the great diagnostic impact of endoscopic retrograde cholangiopancreatography (ERCP) which allows one to obtain fluoroscopic imaging and tissue sampling through brush cytology and/or forceps biopsy, a considerable proportion of cases remain indeterminate, leading to the risk of under/over treated patients. In the last two decades, several endoscopic techniques have been introduced in clinical practice, shrinking cases of uncertainties and improving diagnostic accuracy. The aim of this review is to discuss recent advances and emerging technologies applied to the management of biliary tree disorders through peroral endoscopy procedures.
Highlights
A meta-analysis found the pooled sensitivity and specificity of brush cytology of 45% and 99%, respectively, compared to 48.1% and 99.2% obtained by intraductal biopsy in the evaluation of biliary strictures; the combination of both modalities improved the sensitivity to only 59% [14]
With the peroral cholangioscopy the biliary tree is achieved through the patient’s mouth. It can be performed via direct advancement of an endoscope into the bile ducts or indirectly, with the so called “mother-baby system”, where a cholangioscope is entered through the operative channel of a duodenoscope
Data on the diagnostic yield of endoscopic ultrasound (EUS)–fine needle aspiration (FNA) for biliary tract malignancy has been summarized in a review, with a sensitivity ranging between 43–94%, a specificity of 100%, and an accuracy of 70–94% [7]
Summary
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