Original articleClinical endoscopyEUS-FNA is superior to ERCP-based tissue sampling in suspected malignant biliary obstruction: results of a prospective, single-blind, comparative study
Section snippets
Methods
At our center, same-session EUS and ERCP are routinely offered for all patients with suspected pancreaticobiliary pathology. All patients with suspected malignant biliary obstruction based on clinical presentation of painless jaundice with elevated levels on liver tests in a cholestatic pattern and evidence of biliary obstruction, stricture, or pancreatic/biliary mass on preprocedure imaging (contrast CT or magnetic resonance imaging) were invited to participate in the study. Patients with
Results
Between May 2011 and June 2012, a total of 77 patients with clinical suspicion for malignant biliary obstruction provided informed consent to participate in this prospective study. After the initial EUS, 26 patients patients were excluded from the study for the following reasons: (1) EUS-FNA provided on-site diagnosis of a resectable neoplasm, patient referred for expedited surgery without ERCP drainage (n = 14); (2) biliary stricture not present on ERCP (stones or other cause of biliary
Discussion
We directly compared EUS-FNA with ERCP-based tissue sampling in a large series of unselected patients with suspected malignant biliary obstruction. Surprisingly, there is a paucity of studies that compare these sampling techniques. Oppong et al15 performed a retrospective analysis of EUS-FNA compared with ERCP brushings in a series of 37 patients with suspected malignant obstruction. In their study, ERCP was performed before EUS-FNA, procedures were performed in a single session in only 56% of
References (30)
- et al.
Value of endobiliary brush cytology and biopsies for the diagnosis of malignant bile duct stenosis: results of a prospective study
Gastrointest Endosc
(1995) - et al.
Triple-tissue sampling at ERCP in malignant biliary obstruction
Gastrointest Endosc
(2000) - et al.
Endoscopic retrograde forceps biopsy and brush cytology of biliary strictures: a prospective study
Gastrointest Endosc
(1995) - et al.
EUS-guided FNA for the diagnosis of solid pancreatic neoplasms: a meta-analysis
Gastrointest Endosc
(2012) - et al.
Diagnosis of pancreatic neoplasia with EUS and FNA: a report of accuracy
Gastrointest Endosc
(2010) - et al.
Use of EUS-FNA in diagnosing pancreatic neoplasm without definitive mass on CT
Gastrointest Endosc
(2013) - et al.
Lower frequency of peritoneal carcinomatosis in patients with pancreatic cancer diagnosed by EUS-guided FNA vs percutaneous FNA
Gastrointest Endosc
(2003) - et al.
A randomized comparison of EUS-guided FNA versus CT or US-guided FNA for the evaluation of pancreatic mass lesion
Gastrointest Endosc
(2006) - et al.
ERCP or EUS for tissue diagnosis of biliary strictures? A prospective comparative study
Gastrointest Endosc
(2004) - et al.
Role of EUS for preoperative evaluation of cholangiocarcinoma: a large single-center experience
Gastrointest Endosc
(2011)
EUS-guided FNA of proximal biliary strictures after negative ERCP brush cytology results
Gastrointest Endosc
Utility of EUS in patients with indeterminate biliary strictures and suspected extrahepatic cholangiocarcinoma
Gastrointest Endosc
Identification of cholangiocarcinoma by using the Spyglass Spyscope System for peroral cholangioscopy and biopsy collection
Clin Gastroenterol Hepatol
Diagnostic accuracy of conventional and cholangioscopic-guided sampling of indeterminate biliary lesions at the time of ERCP: a prospective, long-term follow-up study
Gastrointest Endosc
ERCP with cholangiopancreatoscopy may be associated with higher rates of complications than ERCP alone: a single-center experience
Gastrointest Endosc
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Endoscopic Diagnosis of Cholangiocarcinoma
2022, Techniques and Innovations in Gastrointestinal EndoscopyCitation Excerpt :EUS-FNA identified 100% of dCCA and 83% of pCCA.99 Several other studies showed similar findings.89–92,98–101 Moreover, the presence of an associated mass lesion significantly improves the diagnostic yield.
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Shah at [email protected].
See CME section; p. 152.