The outcomes of Endoscopic Ultrasound in the Management of Indeterminate Extra Hepatic Biliary Strictures: A Retrospective Study In a South African Tertiary Centre

Abstract

Introduction: The diagnosis of indeterminate biliary stricture (IBS) remains a challenge. Endoscopic ultrasound (EUS) has been used to avoid unnecessary surgery. Methods: Prospectively collected EUS data at Chris Hani Baragwanath Academic Hospital was analysed. Patients with indeterminate biliary strictures on imaging and/or previous ERCP were included. Demographic, clinical, radiological, operative, and pathological data from April 2016 to August 2021 was analysed. Results: Thirty-three patients (23 males) presented with an IBS and underwent EUS. The median age was 55 years (25-76). Pre-EUS diagnoses included possible chronic pancreatitis (n=9), stone related stricture (n=6), periampullary/intraductal mass (n=3). In 15 cases no presumptive diagnosis was possible. EUS visual assessment suspected malignancy in 8 patients and benign disease in 25 patients. Six of 8 suspected malignant strictures were confirmed, 3 by EUS-FNA, 2 post-surgical resections, and one by cytology at ERCP. Sixteen of the 25 benign patients had confirmatory diagnoses of stone disease (n=8), benign stricture (n=4), and chronic pancreatitis (n=2). One suspected benign case had adenocarcinoma in the background of chronic pancreatitis. In 11 patients the follow-up data was incomplete. Overall, EUS had a sensitivity, specificity and accuracy of 85.71% (95%CI 42.13%-99.64%), 100.00% (76.84% to 100.00%) and 95.24% (95%CI 76.18%-99.88%) respectively. Conclusion: EUS is a useful adjunct as a diagnostic tool in patients with indeterminate biliary stricture. Further investigation is warranted to confirm these findings.