Aims Defining the etiology of biliary stenosis is challenging, and endoscopic tissue sampling
often shows a low diagnostic yield. We evaluated the diagnostic yield of endoscopic
ultrasound (EUS) fine-needle aspiration/biopsy (FNA/FNB) and endoscopic retrograde
cholangiopancreatography (ERCP) brushing/biopsy in biliary stenosis
Methods We retrospectively reviewed EUS-FNA/FNB and ERCP procedures performed in patients
with biliary stenosis from November 2015 to September 2021 at the Policlinico Tor
Vergata, Rome, Italy. Final diagnosis was obtained from surgical specimens or clinical/radiological
follow-up
Results Fifty-two patients (31 males; median age 73, range 49-94) underwent 75 endoscopic
procedures: 46 ERCP with brushing/biopsy, 23 EUS-FNB, 6 EUS-FNA (15 patients underwent
both ERCP and EUS sampling; 4 patients underwent 2 ERCP, 1 patient 3 ERCP and 2 patients
2 EUS-FNA/FNB after negative histology/cytology). Malignancy was diagnosed in 28/52
(53.8%) patients. The sensitivity, specificity, and diagnostic accuracy of ERCP brushing/biopsies
were 66.7%, 100%, and 84.8% respectively, and those of EUS- FNA/FNB were 71.4%, 100%,
and 80%, respectively. In the cases in which both EUS-FNA/FNB and ERCP were performed,
sensitivity, specificity and diagnostic accuracy were 81.8%, 100% and 86.6%.
Overall, sensitivity, specificity and diagnostic accuracy of endoscopic sampling with
EUS-FNA/FNB or ERCP in our population were 80.6%, 100% and 90%.
Conclusions Endoscopic tissue sampling with EUS-FNA/FNB and/or ERCP brushing/biopsies showed
high diagnostic yield in patients with biliary stenosis. In selected cases, performing
both procedures increases sensitivity and diagnostic accuracy compared to individual
procedures
