ADVANCED DIAGNOSTIC OF BILE DUCT STRICTURES OF UNCERTAIN ETIOLOGY WITH COMBINED EUS-ERCP

Aims Often, ERCP with brush cytology (ERCP-BC) is imperfect for the diagnosis of biliary strictures of unknown etiology. Complementary endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) might be beneficial in such scenarios. Our aim was to investigate the diagnostic accuracy of ERCP-BC and EUS-FNA in unclear biliary strictures.

Methods In a prospective, tertiary-center setting, patients were examined with both ERCP and EUS during endoscopic work-up (EUS+ERCP). The results were compared with surgery, clinical follow-up, and imaging. The main outcome measurements were: Diagnostic sensitivity, specificity, accuracy, and adverse event rate of ERCP-BC, EUS-FNA, and the combination of both sampling methods (ERCP-BC+EUS-FNA).

Results During 2012–2020, 73 patients (m/f: 50/23; median age: 54) were examined with EUS+ERCP (ERCP-BC+EUS-FNA n=22, ERCP-BC only n=41, EUS-FNA only n=5, ERCP+EUS without sampling n=5). Final diagnoses were benign in 43 cases (PSC n=17, other benign diagnosis n=26) and malignant in 30 cases (CCA n=17, pancreatic cancer n=11, other malignancy n=2).

The adverse event rate was in ERCP-BC only (n=41) 2/41 (5%: pancreatitis n=2), while in ERCP-BC+EUS-FNA (n=22) was 1/22 (5%: cholangitis n=1), p=ns.

In ERCP-BC only (n=41), the sensitivity, specificity and accuracy of ERCP-BC was 53%, 92% and 76% respectively. In combinatory procedures (n=22), the diagnostic sensitivity, specificity and accuracy of ERCP-BC+EUS-FNA and ERCP-BC was (86 vs 44%) p=0.25, (86 vs 92%) p=1.0, and (86 vs 73%) p=0.25, respectively.

Conclusions In the diagnosis of unclear biliary strictures of unknown etiology the combination of EUS-FNA and ERCP-BC was patient-safe and demonstrated high sensitivity, numerically superior to ERCP with brush cytology only.

Publication History

Article published online:
14 April 2022