Endoscopic transpapillary bile duct biopsy without sphincterotomy for diagnosing biliary strictures: a prospective comparative study with bile and brush cytology.

OBJECTIVES: Endoscopic transpapillary bile duct biopsy has a high sensitivity for detection of malignant biliary strictures, but is commonly performed after endoscopic sphincterotomy. We performed transpapillary biopsy without sphincterotomy, using a recently developed, malleable biopsy forceps, and prospectively studied the usefulness of this diagnostic procedure, compared with that of bile and brush cytology.
METHODS: We succeeded in transpapillary biopsy without sphincterotomy in 45 (87%) of 52 patients. In 43 patients with biliary strictures (31 malignant, 12 benign) who successfully underwent all endoscopic samplings by bile aspiration, brushing, and biopsy, the diagnostic value of these three sampling methods was compared.
RESULTS: Transpapillary biopsy (81%) had a significantly higher level of sensitivity for malignancy than bile (32%) and brush (48%) cytology. Transpapillary biopsy was more sensitive for bile duct cancer (88%) than for pancreatic cancer (71%), as were cytology techniques. No false positives were found in any of the three sampling methods. No complications accompanied the endoscopic procedures.
CONCLUSIONS: Transpapillary bile duct biopsy without sphincterotomy is a simple, safe, and effective technique for diagnosing biliary stricture. We recommend that this technique be performed routinely at initial endoscopic retrograde cholangiopancreatography for patients with a stricture or filling defect of the extrahepatic bile duct.