Original articleEndoscopic ultrasound-guided fine needle aspiration biopsy of suspected cholangiocarcinoma
Section snippets
Patients and methods
Over a 23-month period, all patients (n = 28) undergoing EUS for evaluation of common bile duct strictures were prospectively identified. This study was given expedited approval by the Institutional Review Board of the University of Alabama at Birmingham.
Patients included in the study were strictly limited to those with suspected cholangiocarcinoma based on the clinical history, imaging studies including ERCP, percutaneous transhepatic cholangiogram (PTC), computed tomography (CT) and magnetic
Results
EUS detected a bile duct abnormality in (25/28) 89% of the patients evaluated. The mean age of the 25 patients was 67 years (SD ± 11), and there were 18 men and 7 women. Only 1 patient was known to have ulcerative colitis and primary sclerosing cholangitis. The majority of the patients (91%) presented with obstructive jaundice and had nondiagnostic bile duct brushings at ERCP (88%). Two additional patients had nondiagnostic brushings at percutaneous transhepatic cholangiogram (PTC) and 1 had a
Discussion
Despite advances in endoscopic techniques for sampling bile duct strictures, the diagnosis of cholangiocarcinoma remains elusive. As with any suspected neoplasm, a tissue diagnosis is essential to guide therapy. In a select cohort of patients with biliary strictures suspicious for carcinoma, all of whom had no diagnosis established by conventional nonoperative means, we were able to visualize the tumor by EUS in all but 3 patients with tumors in the extrahepatic bile duct, perihilar area, and
Acknowledgements
The authors thank Brenda McKenzie for her expert help with this manuscript.
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