GASTROENTEROLOGY ARTICLE OF THE WEEK
May 29, 2003
De Bellis M, Sherman S, Fogel EL, et al. Tissue sampling at ERCP in suspected malignant biliary strictures (Part 2). Gastrointestinal Endosc 2002;56:720-730.
1. Brush cytology in the diagnosis of biliary malignancy
a. the sensitivity is 30% to 57% in most studies
b. removing the brush and sheath as one unit may increase sensitivity
c. brushing after dilating a stricture significantly increases yield for malignancy
d. lack of malignancy found after three separate brushing sessions (on different
days) reduces the likelihood of cholangiocarcinoma to < 6%
e. in a single ERCP session, brushing with 2 consecutive brushes is
recommended to increase yield.
True or False
2. Endobiliary biopsy samples obtained during ERCP appear to be the most sensitive of all tissue sampling techniques for biliary strictures.
3. Because most biliary strictures are caused by pancreatic cancer, obtaining tissue samples from the pancreatic duct may enhance the likelihood of diagnosis and is possible in the majority of patients.
4. The easiest way of increasing sensitivity for malignancy during ERCP is to perform two separate brushings in the same session.
5. When using endobiliary biopsy forceps, at least 3 specimens should be obtained.
6. Tissue sampling of biliary strictures with 2 or more techniques is the most effective method for obtaining a tissue diagnosis of cancer at ERCP.
7. A patient with suspected malignant obstructive jaundice is deemed resectable based on US and CT studies. You should
a. proceed with ERCP to get a “road map” and confirm the presence of
malignancy
b. proceed with EUS and or dual phase CT to be sure the patient is an operative
candidate, no need for ERCP
c. if tissue diagnosis is required, EUS-FNA is the preferred method, with yields
of 75% to 93%.
d. proceed with ERCP to lower bilirubin levels in preparation for surgery