Performance of bile aspiration plus brushing to diagnose malignant biliary strictures during endoscopic retrograde cholangiopancreatography

摘要

Background and study aims: Endobiliary brushing during endoscopic retrograde cholangiopancreatography (ERCP) is the main technique used to diagnose a malignant stricture, but has a poor sensitivity. This study evaluated the diagnostic performance of bile aspiration associated with biliary brushing during ERCP to diagnose a malignant stricture, compared to brushing alone. Patients and methods: Between January 2007 and December 2012, all consecutive patients undergoing ERCP to treat a biliary stricture were included. After a biliary sphincterotomy, 3?mL to 10?mL of bile was aspirated into the brush catheter and collected in a dry sterile tube before and after brushing (to yield three samples). Brushing was performed as commonly recommended. Results: One hundred eleven patients (68 males, 43 females) were included; mean age 67?±?15.4 years. A final diagnosis of malignant stricture was established in 51 patients, including 43 cholangiocarcinomas; 60 patients had benign strictures. Specificity (Sp) and positive predictive values were 100% for all samples. The diagnostic performance of the three-sample combination of bile aspiration?+?brushing?+?bile aspiration was significantly greater than brushing alone (P?=?0.004): sensitivity (Se)?=?84.3?% vs. Se?=?66.7?%. The three-sample combination gave a negative predictive value of 88.2?%, and a diagnostic accuracy of 92.8?%. When suspicious results were added to malignant results as positive results, the three-sample combination gave Sp?=?91.7?% and Se?=?94.1?%. Conclusions: In cases of biliary stricture, conducting bile aspiration before and after brushing significantly increased the ability to diagnose a malignant stricture with a sensitivity of 84.3?% (P?=?0.004).