Nam Q Nguyen1, Mark N Schoeman2, Andrew Ruszkiewicz3. 1. Department of Gastroenterology & Hepatology, Royal Adelaide Hospital, Adelaide, South Australia; Department of Medicine, University of Adelaide, Adelaide, South Australia. 2. Department of Gastroenterology & Hepatology, Royal Adelaide Hospital, Adelaide, South Australia. 3. Surgical Pathology, SA Pathology, Adelaide, South Australia.
Abstract
BACKGROUND: Biliary tract malignancies can be assessed with either EUS or SpyGlass cholangioscopy (SGC). OBJECTIVE: To evaluate the impact of EUS and guided biopsy before considering SGC in patients who had biliary strictures with negative ductal brushing. DESIGN: Prospective, observational study. SETTING: Tertiary level referral hospital. PATIENTS: Forty consecutive patients with biliary strictures. INTERVENTION: EUS evaluation and biopsy, where possible, were performed in all patients. If EUS examination failed to provide a definitive diagnosis, SGC and ductal biopsy was performed. Results were compared with surgical specimens or positive histocytology. MAIN OUTCOME MEASUREMENTS: Tissue diagnosis, technical success, adverse events, and clinical outcomes. RESULTS: On EUS, abnormalities responsible for the biliary strictures were identified in 39 patients (98%), with FNA achievable in 30 patients (75%). EUS-FNA provided positive histocytology in 23 patients (58%). SGC-guided biopsy was performed to evaluate nondiagnostic EUS-FNA (17 patients) and to clarify autoimmune pancreatitis on FNA (2 patients). The procedure was successful in 18 patients (95%) and provided tissue diagnosis in 16 patients (88%), with 2 false-negative results from extrinsic pathologies. When EUS was used before the SGC approach, the need for SGC was avoided in 24 patients (60%), cholangitis was minimized in 2.5%, and a cost saving of U.S.$110,000 was realized. Tissue diagnosis was achieved in 38 patients (94%) with this approach. LIMITATIONS: Relatively small sample size. CONCLUSIONS: EUS evaluation in patients with difficult biliary stricture prevents the need, cost, and adverse events of SGC in 60% of patients. Together, EUS followed by the SGC approach provides correct clinical diagnosis in 94% of patients with minimal adverse events.
BACKGROUND:Biliary tract malignancies can be assessed with either EUS or SpyGlass cholangioscopy (SGC). OBJECTIVE: To evaluate the impact of EUS and guided biopsy before considering SGC in patients who had biliary strictures with negative ductal brushing. DESIGN: Prospective, observational study. SETTING: Tertiary level referral hospital. PATIENTS: Forty consecutive patients with biliary strictures. INTERVENTION: EUS evaluation and biopsy, where possible, were performed in all patients. If EUS examination failed to provide a definitive diagnosis, SGC and ductal biopsy was performed. Results were compared with surgical specimens or positive histocytology. MAIN OUTCOME MEASUREMENTS: Tissue diagnosis, technical success, adverse events, and clinical outcomes. RESULTS: On EUS, abnormalities responsible for the biliary strictures were identified in 39 patients (98%), with FNA achievable in 30 patients (75%). EUS-FNA provided positive histocytology in 23 patients (58%). SGC-guided biopsy was performed to evaluate nondiagnostic EUS-FNA (17 patients) and to clarify autoimmune pancreatitis on FNA (2 patients). The procedure was successful in 18 patients (95%) and provided tissue diagnosis in 16 patients (88%), with 2 false-negative results from extrinsic pathologies. When EUS was used before the SGC approach, the need for SGC was avoided in 24 patients (60%), cholangitis was minimized in 2.5%, and a cost saving of U.S.$110,000 was realized. Tissue diagnosis was achieved in 38 patients (94%) with this approach. LIMITATIONS: Relatively small sample size. CONCLUSIONS: EUS evaluation in patients with difficult biliary stricture prevents the need, cost, and adverse events of SGC in 60% of patients. Together, EUS followed by the SGC approach provides correct clinical diagnosis in 94% of patients with minimal adverse events.
Authors: Wim Laleman; Kristof Verraes; Werner Van Steenbergen; David Cassiman; Frederik Nevens; Schalk Van der Merwe; Chris Verslype Journal: Surg Endosc Date: 2016-09-07 Impact factor: 4.584