Role of Endoscopic Ultrasonography in Diagnosis of Distal Biliary Stricture Without Mass on Cross Sectional Imaging

Aims This study aims to evaluate the accuracy of EUS in identifying the underlying causes of distal biliary strictures (DBS) lacking definitive diagnoses.

Methods The study comprised 36 patients with distal CBD stricture without mass causing the stricture on cross-sectional CT or MRI. EUS was employed to differentiate between benign and malignant strictures. Final diagnosis of underlying stricture was considered malignant based on histopathological examination either of the taken biopsy or surgically removed tissues. Patients were considered to have benign strictures were followed-up for 6 months, clinically, laboratory, and by imaging with abdominal CT, MRCP, and EUS if needed. Any confirmed malignancy detected during the follow up period was considered as end point of follow up for this case [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17].

Results EUS demonstrated a sensitivity of 90% and specificity of 71.4% in accurately identifying distal biliary stricture without mass on cross sectional imaging. After six months of follow-up, EUS maintained sensitivity and specificity rates of 87% and 100%, respectively. Malignant strictures were associated with significant weight loss and elevated levels of aspartate aminotransferase (AST), alanine transaminase (ALT), direct bilirubin, cancer antigen 19-9 (CA 19-9), and carcinoembryonic antigen (CEA).

Conclusions EUS is a very good diagnostic modality in patients with distal biliary stricture without mass on cross sectional imaging. The suggestive EUS criteria of malignancy in form of presence of irregular hypoechogenic mass disrupting bile duct layers and continued into adjacent tissues are reliable in most cases.

 

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Conflicts of interest

Authors do not have any conflict of interest to disclose.

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Publication History

Article published online:
27 March 2025