S3208 The Use of ERCP in the Diagnosis of Indeterminate Biliary Strictures: Experience From a Large Tertiary Care Center

Abstract

Introduction: The diagnosis of indeterminate biliary strictures remains a challenge for the endoscopist and the sensitivity of ERCP based diagnostic methods such as brush cytology is relatively low, usually not exceeding 60%. The aim of this study is to look at the diagnostic performance of ERCP and ancillary techniques in the diagnosis of indeterminate biliary strictures. Methods: we have identified a retrospective cohort of patients who had ERCP for the diagnosis of indeterminate biliary strictures, excluding pancreatic malignancy or metastases from 1/2010 to 8/2020. Data was collected including demographics, type of diagnostic procedure, procedural details, cytology/pathology results from the specimen and need for repeat interventions. Results: A total of 116 patients were identified and 169 ERCP procedures were performed. 42 (36%) patients were male, 82 (71%) were white and the median age was 69 (IQR: 54-69). 59 (51%) patients had brushings alone, 33 (28%) brushings and forceps biopsy combined, 9 (8%) forceps biopsy alone and 15 (13%) had cholangioscopy and direct biopsies. The results of the pathology/cytology after the first ERCP were benign in 55 (46%), atypia in 32 (28%) and malignant in 29 (25%). DNA and FISH analysis of was done in 10 (9%). In 37 (32 %) patients a repeat ERCP was required and the median number of repeat ERCPs was 3 (IQR: 2-3). After a repeat ERCP, 8 (22%) lesions were reported to be malignant. The final diagnosis as malignant cholangiocarcinoma by ERCP was done on 37 (32%) of the patients. The accuracy of detection malignancy during the first ERCP was 54 % by brushings, 51 % by brushings and biopsy and 56 % by cholangioscopy (Table 1). Conclusion: ERCP with the different ancillary techniques are essential for the diagnosis of indeterminate biliary strictures. The combination of these methods with reintervention can increase cancer detection rates on indeterminate biliary strictures with or without FISH and DNA analysis. As described in other publications, we could reproduce a very high sensitivity and overall accuracy for the diagnosis of malignant strictures.Table 1.: Outcomes.