Mo1473 Endoscopic Papillary Large Balloon Dilation for Revision of Old Sphincterotomy in Recurrent Bile Duct Stones

Abstract

between January 2008 and October 2010 were included in this study. Cytological analysis was performed using two techniques. Technique A (new technique) involved presence of a dedicated cytotechnician during tissue acquisition, use of a long biliary brush cut directly into buffered methanol, preparation of slide using ThinPrep© and final analysis by dedicated Consultant Cytopathologists. Technique B involved tissue acquisition using a standardbrush, smeared directly onto a slide and transported to the laboratory for analysis. Cytological diagnosis was classified as either negative (including reactive), or malignant (suspicious for or definite cancer). Cytology results were compared with final diagnosis as determined by histopathologic diagnosis, clinical follow-up, or autopsy data. Results: During this period, 111 bile duct brushings were obtained. Four patients lacked a final diagnosis and were excluded from the study, leaving a final cohort of 107 patients. Technique A was employed in 48 cases with a mean age( SD) of 72.6( 10.1) years. Statistical analysis provided sensitivity of 73%, specificity of 91% and a positive predictive value of 96%. Technique B was used in 59 cases with a mean age( SD) of 71.1( 16.0) years. Statistical analysis provided sensitivity of 31%, specificity of 100% and a positive predictive value of 100%. Conclusion: The introduction of this new technique of tissue acquisition and cytological assessment during biliary brushings has dramatically increased sensitivity from 31% to 73%, improving cancer detection rates.