Concise Commentary: Why Cholangioscopy for Indeterminate Biliary Strictures in PSC Is Still Not Good Enough

Excerpt

Primary sclerosing cholangitis (PSC) is a major risk factor for the development of hepatobiliary malignancy with around 20% of patients developing cholangiocarcinoma (CCA) [1]. More than 50% of PSC patients develop high-grade (mostly benign) bile duct strictures during the course of the disease that complicate disease management, since the accurate diagnosis of indeterminate biliary strictures is challenging. Since early CCA can mimic benign strictures, early diagnosis of CCA is crucial in order to facilitate timely curative resection. Since cross-sectional imaging with CT or MRI usually cannot differentiate between benign and early-stage malignant stricture, ERCP with brush cytology and transpapillary biopsies is therefore required. Biliary brushings and biopsies are associated with high specificity but low sensitivity (40–50%) for the detection of CCA. The addition of fluorescence in situ hybridization (FISH) is reported to increase sensitivity by about 10–15%. …