ABSTRACT
Objective:To study the combined use of endoscopic balloon dilation with endoscopic biliary brushings in diagnosis of bile duct strictures.Methods:A prospective single center study was conducted at the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology. All patients with suspected malignant bile duct strictures shown on CT or MRI imaging from January 2018 to January 2020 were reviewed. All patients gave informed consent to the endascopic retrograde cholangiopancreatography procedures. Their clinical and follow-up data were analyzed. All patients underwent endoscopic balloon dilation of bile duct strictures. Before and after balloon dilation, biliary brush cytology was performed, and the results were used to classify the patients into the control group and the experimental group. Pathological examination of the brush cytology samples was carried out by a single chief pathologist. Presence of cancer cells or significant heterogeneous cells indicated a positive brush cytology test. Negative patients who still highly consider cholangiocarcinoma and agree to surgery and whose gross specimen is confirmed to be malignant after surgery should be considered as false negative by brush examination; it is difficult to judge that patients with cholangiocarcinoma have progress after 2 months of follow-up should be considered as false negative by brush examination. Any progression of disease indicated that the brush test was wrong and the test was again classified as false negative. Only when there was no progression of strictures was the possibility of a benign biliary stricture being considered. The advantage test (McNemar test) was used to analyze the difference between the two diagnostic methods.Results:Of 39 patients who were included in this study, there were 26 males and 13 females, with an age of (68.0 ± 5.2) years. Cholangiocarcinoma was diagnosed by histopathology, surgery or at 2 months follow-up in 35 patients. In the control group, 17 patients had a positive brush test (sensitivity rate was 48.6%, 17/35). In the experimental group, 26 patients had a positive brush test (sensitivity rate was 74.2%, 26/35). In addition, 2 patients in the control group had a positive brush test, while in the experimental group, a negative brush test. A total of 28 patients were positive in the two groups. The sensitivity rate of the brush test was 80.0% (28/35). There were significant differences between the two groups ( P<0.05). Conclusion:Endoscopic balloon dilation combined with endoscopic biliary brushings improved the sensitivity of pathological diagnosis of cholangiocarcinoma, and endoscopic biliary brushings before and after balloon dilation improved the sensitivity of diagnosis.
ABSTRACT
Objective To explore the clinical value of fecal calprotectin (FCP) in peptic ulcer (PU) as an non-invasive indicator of disease activity compared with gastroscope. Methods The study was conducted in 62 patients with PU confirmed by endoscopy ( PU group) and 30 subjects with normal findings under endoscopy ( control group). Fecal sample ( weight 5-10 g) was collected within 3 days after endoscopy and FCP was measured by emzyme-linked immunosorbent assay (ELISA). The case history and clinical data were collected as well. Results The level of FCP in PU group was significantly higher than that in control group ( 154. 72 μg/g vs. 25. 18 μg/g, P < 0.001 ). In patients with PU at active stage ( n = 32), the level of FCP was significantly higher than that at scar stage (n =30,318.34 μg/g vs. 54. 10 μg/g, P <0. 01 ), and that in control group (25.18 μg/g, P <0.01), while there was no significant difference in FCP between the latter two groups ( P >0. 05 ). The level of FCP had no significant correlation with the location, size or number of the ulcer. Among patients in PU group, the level of FCP in patients presented with haematemesis or melena ( n = 20) was significantly higher than that in patients presented with other symptoms ( n = 42, 1257. 41 μg/g vs. 92. 77 μg/g, P < 0. 01 ). Conclusion The level of FCP is closely correlated with the activity of PU, which is significantly higher at active stage than that at scar stage, as well as in PU patients with bleeding than those without. Measurement of FCP is a convenient and noninvasive method with well compliance of patients, which might be used as an indicator of disease activity in PU.