Authors (including presenting author) :
Ho KK (1), Lai SW (1)
Affiliation :
(1) Medicine and Geriatrics, Pok Oi Hospital
Keyword 2: :
common bile duct
Keyword 4: :
indeterminate biliary stricture
Keyword 5: :
biliary stricture
Introduction :
Indeterminate biliary strictures (IDBS) remain a diagnostic challenge despite advances in endoscopic sampling and cross-sectional imaging. Acquisition of specimens is vital to allow specific treatments. Endoscopic retrograde cholangiopancreatography(ERCP)-guided tissue sampling is often inconclusive. Advanced endoscopic techniques such as endoscopic ultrasound (EUS) and cholangioscopy have reported good sensitivity and accuracy.
Objectives :
The objective is to see the characteristics and practice in EUS and cholangioscopy and their applications to clinical use in the evaluation of IDBS.
Methodology :
This retrospective cohort study recruited 175 patients (median age 64.8 years, 68.6% male) with common bile duct strictures found on ERCP with a negative index intraductal sampling and no definitive mass on cross-sectional imaging. Diagnosis was confirmed via postoperative pathology, the presence of alternative diagnoses, and/or being alive and clinically well at one year’s follow-up. The impact of advanced endoscopy on management was analysed.
Result & Outcome :
Malignancy was reported in 69/175 patients. 59 patients had benign or inflammatory strictures and 32 had IgG4-related disease (IgG4-RD). Advanced endoscopy aided in the achievement of correct diagnosis in 64/88 (72.7%) patients, including 30 benign diagnoses and 21 exact malignant diagnoses; most of whom then proceeded directly with personalised treatment. There were three false positives and one false negative (4.4%). When advanced endoscopy was readily available, time to diagnosis for all conditions was not delayed and for IgG4-RD was significantly shorter. In the modern era where benign but treatable conditions such as IgG4-RD is more well-known and oncology treatment for specific cancer types are increasingly available, EUS and cholangioscopy are able to provide exact diagnoses without delays, allow earlier direct personalised treatment or intervention, and avoid unnecessary operations. Repeat advanced endoscopy or cross-sectional imaging may be helpful to safety net false negatives.
