New Method of Biliary Sampling for Cytopathological Examination During ERCP

December 28, 2006

Am J Gastroenterol. 2006 Dec 11 [Epub ahead of

print]

A

New Method of Biliary Sampling for Cytopathological

Examination During Endoscopic Retrograde Cholangiography.

Dumonceau JM, Casco C, Landoni N, Frossard JL, Hadengue A, Pache JC, Genevay M, Morel P, Kumar N, Bongiovanni M.

Service of Gastroenterology & Hepatology, Geneva, Switzerland.

OBJECTIVES: Biliary brushing during endoscopic

retrograde cholangiography (ERC) may allow the

diagnosis of cancer, but this technique is limited by a low (18-57%)

sensitivity. We compared the cellular and diagnostic

yields of a new sampling method (using stricture dilation and a grasping

basket) with those of brushing. METHODS: Sixty

consecutive patients with a suspected malignant obstruction of the common bile

duct were included in a consecutive, nonrandomized order. They

underwent sampling during ERC using the new method (study patients, N = 30) or

a brush (control patients, N = 30). A final diagnosis

of cancer was made in 22/30 (73%) study patients and 21/30 (70%) control

patients. At the end of the study period, all smears

were interpreted at cytopathological examination in a

blind and random fashion for cellularity

(insufficient, low, moderate, or high) and diagnosis (normal, atypical

considered reactive, highly atypical suspicious for cancer, or malignant). " Highly atypical " and " malignant "

diagnoses were considered as indicative of cancer. RESULTS:

Compared with biliary brushing, the new method provided a high cellular yield

in more cases (19/30 vs 10/30, P= 0.020), a higher

sensitivity for the detection of cancer (19/22 [86%]vs

11/21 [52%], P= 0.015), and a higher diagnostic accuracy (27/30 [90%]vs 20/30 [67%], P= 0.028). Specificity

for the detection of cancer was 100%. The 30-d

complication rate observed with the new method was 3%. CONCLUSIONS:

Significantly higher cellular and diagnostic yields can be obtained at ERC in

patients with suspected malignant biliary stricture by combining stricture

dilation and a grasping basket compared with brushing.

PMID: 17156144 [PubMed - as supplied by publisher]

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