The Yield of Brush Cytology During ERCP for Diagnosing Pancreatic Adenocarcinoma Reduces Patient Risk and Promotes Green Endoscopy

Aims Pancreatic adenocarcinoma (PAC) and cholangiocarcinoma (CC) often present late. ESGE recommends EUS-guided sampling as the first line procedure for PAC diagnosis. While CC requires ERCP+brush cytology or targeted biopsy using cholangioscopy for diagnosis. Although the specificity of the brush cytology is almost 100%, sensitivity is low (40%) but when combined with fluorescence in situ hybridization (FISH) it rises to ~90%. We analyzed the yield of brush cytology during ERCP in PAC with obstructive jaundice to avoid the need for EUS+FNB.

Methods We conducted a retrospective cohort study of all patients diagnosed with PAC or CC from 2018-2024 and who underwent ERCP+brush cytology (without FISH) with or without EUS+FNA/FNB

Results We identified n=122 patients with PAC and n=18 with CC. A total of n=46 (33%) who required ERCP for obstructive jaundice had brush cytology for either PAC or CC, 53% male, mean age 78 yrs. Twenty-eight (61%) were diagnosed with PAC and n=18 (39%) with CC. Brush cytology was positive in n=40 (87%) with PAC and CC. Among the PAC patients who underwent brush cytology during ERCP, n=23 (82%) had positive brush cytology, and among these, n=8 (29%) underwent only brush cytology during ERCP and did not require EUS+FNA. Brush cytology was positive in n=17 CC patients (95%). The one patient with negative brush cytology was diagnosed with CC per liver biopsy

Conclusions We demonstrated the advantage of performing brush cytology in PAC patients who required ERCP for obstructive jaundice thereby avoiding the need for an additional invasive procedure in 29% of the patients. This reduces patient risk and promotes green endoscopy

Publication History

Article published online:
27 March 2025