P-175 - Endoscopic pathologic diagnosis for malignant extrahepatic bile duct stricture

Abstract

Introduction: Pathologic confirmation is very important in patients with malignant bile duct strictures irrespective of operability. The numerous studies of diagnostic methods for malignant bile duct strictures report a various limited sensitivity of 43∼81%. We studied the diagnostic yield of endobiliary forceps biopsy, brush cytology, bile cytology and two or three combined in patients with extrahepatic bile duct strictures. Methods: Forty-nine procedures among forty-four patients who were suspected of extrahepatic malignant bile duct strictures were performed between October 2009 and March 2010. We performed one or more of the following three methods: endobiliary forceps biopsy, brush cytology and bile cytology, in patients with suspected malignant extrahepatic bile duct strictures. Endobiliary forcep biopsy and brush cytology were performed during ERCP. Bile cytology was used with bile collected from endoscopic nasobiliary drainage (ENBD) catheter for all day, one to four times. Forty patients were malignant bile duct strictures and four were benign. Results: There were fourteen Klatskin tumors, eight pancreatic cancers, fourteen common bile duct cancers, one hilar invasion of gallbladder cancer, two hilar invasions of intrahepatic cholangiocarcinoma, one hilar invasion of duodenal cancer. Positive results for malignancy were reported in 32/41 procedures (78.0%) by forceps biopsy and in 24/34 procedures (70.6%) by brush cytology and in 18/37 patients (48.6%) by bile cytology. Combination results for malignancy were reported in 26/30 patients (86.7%) by forcep biopsy and brush cytology, in 32/35 patients (91.4%) by forceps biopsy and bile cytology, in 24/29 patients (82.8%) by brush cytology and bile cytology and in 26/27 patients (96.4%) by all three of forceps biopsy, brush cytology and bile cytology.There were no procedure-related serious complications after forceps biopsy or brush cytology. Conclusion: The combination of the two or three of endobiliary forceps biopsy, brush cytology and nasobiliary drainage bile cytology resulted in higher diagnostic yield than single procedure.