How to improve biopsy sampling of bile duct strictures: use small- or large-cup biopsy forceps or imagine another kind of forceps!

摘要

We read with interest the article by Ikeda et al. about the use of large-capacity forceps for obtaining tissue in cases with ex-trahepatic biliary strictures [1]. In this study, the authors compared two different sized biopsy forceps in 32 patients with extrahepatic biliary strictures to determine pathologic diagnostic rate, specimen adequacy, and submucosal tissue sampling rates. They found that biopsies obtained using the large-cup forceps (2.4 mm) yielded a significantly higher diagnostic sensitivity than biopsies obtained using the standard small-cup forceps (1.8 mm). This was particularly true in cases with bile duct cancer (92% vs. 50%, respectively). To date, this is the highest rate of diagnosis reported in the literature, where the range is from 43% to 81 % [2-4]. Overall, including patients with extra-hepatic biliary strictures other than bile duct cancer, Ikeda et al. found that large-cup forceps provided a higher pathologic diagnostic rate (70 % vs. 43 %) and were reported to be much better in adequacy and submucosal tissue sampling than small-cup biopsy forceps [1 ].