The Wire-Grasping Method as a New Technique for Forceps Biopsy of Biliary Strictures: A Prospective Randomized Controlled Study of Effectiveness

BACKGROUND/AIMS: Transpapillary forceps biopsy is an effective diagnostic technique in patients with biliary stricture. This prospective study aimed to determine the usefulness of the wire-grasping method as a new technique for forceps biopsy. METHODS: Consecutive patients with biliary stricture or irregularities of the bile duct wall were randomly allocated to either the direct or wire-grasping method group. In the wire-grasping method, forceps in the duodenum grasps a guide-wire placed into the bile duct beforehand, and then, the forceps are pushed through the papilla without endoscopic sphincterotomy. In the direct method, forceps are directly pushed into the bile duct alongside a guide-wire. The primary endpoint was the success rate of obtaining specimens suitable for adequate pathological examination. RESULTS: In total, 32 patients were enrolled, and 28 (14 in each group) were eligible for analysis. The success rate was significantly higher using the wire-grasping method than the direct method (100% vs 50%, p=0.016). Sensitivity and accuracy for the diagnosis of cancer were comparable in patients with the successful procurement of biopsy specimens between the two methods (91% vs 83% and 93% vs 86%, respectively). CONCLUSIONS: The wire-grasping method is useful for diagnosing patients with biliary stricture or irregularities of the bile duct wall.

Endoscopic Transpapillary Biopsy for the Diagnosis of Patients with Pancreaticobiliary Ductal Strictures / 대한소화기내시경학회지

BACKGROUND AND AIMS: Many diseases and conditions are responsible for pancreaticobiliary ductal strictures. In such patients, histologic diagnosis is crucial to determine therapeutic modalities and to predict their outcomes, as well as to avoid unnecessary operations for tissue diagnosis. To evaluate the diagnostic role of endoscopic transpapillary biopsys (ETPB), this technique was performed in patients with pancreaticobiliary ductal strictures suggestive of malignancy. METHODS: After visualization of the pancreaticobiliary tree and the lesion by endoscopic retrograde cholangiopancreatography (ERCP), an ETPB of the lesion was conducted with or without an endoscopic sphincterotomy (EST) in sixty-four patients with pancreaticobiliary ductal strictures. The biopsy results were analysed according to the morphology of the lesion, site of the stricture, number of biopsys and whether or not an EST was done. RESULTS: The final diagnoses of the sixty-four patients included forty bile duct cancers (62.5%), nine pancreatic cancers (14.1%), four metastatic cancers (6.3%), and eleven benign ductal strictures (17.2%) such as biliary stones, cholangitis, etc. The sites of the strictures were located in the upper bile duct in thirty-two patients (50.0%), the middle bile duct in twenty-two (34.4%), the lower bile duct in three (4.7%), the pancreatic head in four (6.3%), and the pancreatic body in three (4.7%). Adequate tissue specimens for pathologic examination were obtained in fifty-four cases (84.4%). An ETPB was possible without an EST in nineteen cases (29.7%). The ETPB results revealed sensitivity of 60.4% (32/53), specificity of 100% (6/6), positive predictive value of 100% (32/32), and negative predictive value of 34.4% (11/32). The sensitivity of the ETPB was higher in the EST group than in group without an EST. There was no statistical significance however, according to tumor morphology, site, or number of biopsys. CONCLUSIONS: It is recommended that an ETPB, being a safe and effective method, should be performed as a diagnostic procedure during an ERCP for patients with pancreaticobiliary ductal strictures of unknown causes.