Original articleClinical endoscopyComparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis
Section snippets
Medical literature search
A comprehensive search of the medical literature was performed to identify peer-reviewed articles that examined the diagnostic accuracy of endoscopic retrograde biliary brush cytology and intraductal biopsies to detect malignancy as the etiology of biliary strictures. We systematically searched the PUBMED and Embase databases for studies published from January 1980 to April 2014 by using the following search terms: “ERCP brush cytology and forceps biopsy,” “bile duct brush cytology,” and
Eligible studies and quality assessment
An initial medical literature search yielded 1121 articles. After excluding irrelevant studies, 42 potential studies were reviewed in detail. Of these, 9 studies (n = 730 patients) met the inclusion criteria and were included in the analysis.16, 17, 18, 19, 20, 21, 22, 23, 24 The reported pooled estimates were calculated by the random-effects model. Figure 1 shows the flow diagram for studies identified for the systematic review. Table 1 lists the various studies included in the meta-analysis.
Discussion
Pancreatic cancer and CCA usually manifest as biliary strictures that are difficult to differentiate from strictures caused by bile duct stones, chronic pancreatitis, or other benign conditions. Cytological or histological diagnosis of the strictures alters the management plan significantly in terms of aggressive treatment of confirmed malignancies and avoiding unnecessary surgery in benign conditions. ERCP-based tissue diagnosis of suspicious biliary strictures can be achieved with brush
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DISCLOSURE: Dr Vargo is a consultant for Olympus, Boston Scientific, Ethicon Endosurgery, and Cook Endoscopy. Dr Parsi is a consultant for Boston Scientific. All other authors disclosed no financial relationships relevant to this article.
If you would like to chat with an author of this article, you may contact Dr Navaneethan at [email protected].