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Comparison of brush and basket cytology in differential diagnosis of bile duct stricture at endoscopic retrograde cholangiopancreatography

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Hepatobiliary & Pancreatic Diseases International 2014年第6期13卷 622-627页

作者： Ki Bae Bang Hong Joo Kim Jung Ho Park Dong Il Park Yong Kyun Cho Chong Il Sohn Woo Kyu Jeon Byung Ik Kim Department of Internal Medicine Sungkyunkwan University Kangbuk Samsung Hospital 108 Pyung-Dong Jongro-Ku Seoul 110-746 Korea

BACKGROUND： A previous report has identified a significantly higher sensitivity of cancer detection for dedicated grasping basket than brushing at endoscopic retrograde cholangiopancreato- graphy （ERCP）. This study aimed to compare the diagnostic accuracy of Geenen brush and Dormia basket cytology in the differential diagnosis of bile duct stricture. METHOD： The current study enrolled one hundred and fourteen patients who underwent ERCP with both Geenen brush and Dormia basket cytology for the differential diagnosis of bile duct stricture at our institution between January 2008 and December 2012. RESULTS： We adopted sequential performances of cytologic samplings by using initial Geenen brush and subsequent Dormia basket cytology in 59 patients and initial Dormia basket and subsequent Geenen brush cytology in 55 patients. Presampling balloon dilatations and biliary stentings for the stricture were performed in 17 （14.9%） and 107 patients （93.9%）, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of Geenen brush cytology for the diagnosis of malignant bile duct stricture were 75.0%, 100.0%, 100.0%, 66.7% and 83.3%, respectively, and those of Dormia basket cytology were 64.5%, 100.0%, 100.0%, 58.5% and 76.3%, respectively （P=0.347 and 0.827 for sensitivity and accuracy, respectively）. The good and excellent cellular yields （≥grade 2） were obtained by Geenen brush and Dormia basket cytology in 88 （77.2%） and 79 （69.3%） patients, ***： The sensitivity, specificity and accuracy of biliary sampling with a Dormia basket are comparable to those with conventional Geenen brush cytology in the detection of malignant bile duct stricture.

关键词： bile duct stricture cholangiocarcinoma brush cytology basket cytology

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Current endoscopic approach to indeterminate biliary strictures

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World Journal of Gastroenterology 2012年第43期18卷 6197-6205页

作者： David W Victor Stuart Sherman Tarkan Karakan Mouen A Khashab Department of Medicine Johns Hopkins Hospital Baltimore MD 21287 United States Department of Medicine Indiana University School of Medicine Indianapolis IN 46202 United States Department of Medicine Gazi University 06710 Ankara Turkey

Biliary strictures are considered indeterminate when basic work-up, including transabdominal imaging and endoscopic retrograde cholangiopancreatography with routine cytologic brushing, are non-diagnostic. Indeterminate biliary strictures can easily be mischaracterized which may dramatically affect patient's outcome. Early and accurate diagnosis of malignancy impacts not only a patient's candidacy for surgery, but also potential timely targeted chemotherapies. A significant portion of patients with indeterminate biliary strictures have benign disease and accurate diagnosis is, thus, paramount to avoid unnecessary surgery. Current sampling strategies have suboptimal accuracy for the diagnosis of malignancy. Emerging data on other diagnostic modalities, such as ancillary cytology techniques, single operator cholangioscopy, and endoscopic ultrasonography-guided fine needle aspiration, revealed promising results with much improved sensitivity.

关键词： Indeterminate stricture bile duct Single operator cholangioscope Cholangioscopy Endoscopic ultrasound Endoscopic retrograde cholangiopancrea-tography bile duct stricture Indeterminate biliary stricture Confocal microscopy Transpapillary biopsy Cholangiocarcinoma Primary sclerosing cholangitis Spyglass

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Xanthogranulomatous cholangitis causing obstructive jaundice:A case report

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World Journal of Gastroenterology 2006年第27期12卷 4428-4430页

作者： Susumu Kawate Susumu Ohwada Hayato Ikota Kunihiro Hamada Kenji Kashiwabara Yasuo Morishita Department of Surgery Gunma University Graduate School of MedicineGunma 371-8511Japan Clinical Department of Pathology Gunma University HospitalMaebashiGunma 371-8511Japan

This article reports the case of a 34-year-old woman with xanthogranulomatous cholangitis who developed obstructive jaundice. Microscopically, the bile duct was surrounded and narrowed by a xanthogranulomatous lesion, but no xanthogranulomatous cholecystitis was seen. Although percutaneous cholangiograms done via the transhepatic biliary drainage showed smooth narrowing of the upper to middle bile duct, the cytology of bile was diagnosed as class V adenocarcinoma. Therefore, right extended hepatectomy and extrahepatic bile duct resection were performed. The differentiation of benign and malignant strictures at the hepatic hilum is often difficult. Xanthogranulomatous cholangitis is one possible diagnosis of a bile duct stricture. Precise review of all the preoperative information is required to make a correct diagnosis.

关键词： Xanthogranulomatous cholangitis Obstructive jaundice bile cytology bile duct stricture

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Classification of iatrogenic bile duct injury

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Hepatobiliary & Pancreatic Diseases International 2007年第5期6卷 459-463页

作者： Wan-Yee Lau Eric C.H.Lai Department of Surgery the Chinese University of Hong KongShatinNew TerritoriesHong Kong SARChina

BACKGROUND: Iatrogenic bile duct injury continues to be an important clinical problem, resulting in serious morbidity, and occasional mortality, to patients. The ease of management, operative risk, and outcome of bile duct injuries vary considerably, and are highly dependent on the type of injury and its location. This article reviews the various classification systems of bile duct injury. DATA SOURCES: A Medline, PubMed database search was performed to identify relevant articles using the keywords 'bile duct injury', 'cholecystectomy', and 'classification'. Additional papers were identified by a manual search of the references from the key articles. RESULTS: Traditionally, biliary injuries have been classified using the Bismuth's classification. This classification, which originated from the era of open surgery, is intended to help the surgeons to choose the appropriate technique for the repair, and it has a good correlation with the final outcome after surgical repair. However, the Bismuth's classification does not encompass the whole spectrum of injuries that are possible. bile duct injury during laparoscopic cholecystectomy tends to be more severe than those with open cholecystectomy. Strasberg's classification made Bismuth's classification much more comprehensive by including various other types of extrahepatic bile duct injuries. Our group, Bergman et al, Neuhaus et al, Csendes et al, and Stewart et al have also proposed other classification systems to complement the Bismuth's classification. CONCLUSIONS: None of the classification system is universally accepted as each has its own limitation. Hopefully, a universally accepted comprehensive classification system will be published in the near future.

关键词： laparoscopic cholecystectomy bile duct injury bile duct stricture bile leak classification

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Endoscopic diagnosis and treatment of biliary leak in patients following liver transplantation:a prospective clinical study

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Hepatobiliary & Pancreatic Diseases International 2007年第1期6卷 29-33页

作者： Liao, Jia-Zhi Zhao, Qiu Qin, Hua Li, Rong-Xiang Hou, Wei Li, Pei-Yuan Liu, Nan-Zhi Li, De-Ming Huazhong Univ Sci & Technol Tongji Hosp Tonji Med Coll Dept Gastroenterol Wuhan 430030 Peoples R China

BACKGROUND: Orthotopic liver transplantation has been widely used in patients with end-stage liver disease within the last two decades. However, the prevalence of biliary complications after liver transplantation remains high. The most common short-term biliary complication may be biliary leak. So, we examined 13 patients with biliary leak after liver transplantation, attempting to evaluate the role of endoscopic diagnosis and treatment of biliary leak and the incidence of bile duct stricture after healing of the leak. METHODS: Six cases of T-tube leak and seven cases of anastomosis leak complicating liver transplantation were enrolled in this prospective study. Six patients were treated by endoscopic plastic stent placement, two by nasobiliary catheter drainage, two by papillosphincterotomy, and three by nasobiliary catheter drainage combined with plastic stent placement. Some patients received growth hormone treatment. RESULTS: The bile leak resolution time was 10-35 days in 10 patients with complete documentation. The median time of leak resolution was 15.3 days. Four cases of anastomosis stricture, three cases of common hepatic duct and one case of multiple bile duct stenosis were detected by follow-up nasobiliary catheter cholangiography or endoscopic retrograde cholangiopancreatography. CONCLUSIONS: Endoscopic nasobiliary catheter or plastic stent placement is a safe and effective treatment for bile duct stricture occurring after bile leak resolution in most liver transplantation patients. Nasobiliary catheter combined with plastic stent placement may be the best choice for treating bile leak, because, theoretically, it may prevent the serious condition resulting from accidental nasobiliary catheter dislocation, and it may have prophylactic effects on upcoming bile duct stricture, although this should be further confirmed.

关键词： liver transplantation biliary leak bile duct stricture endoscopic therapy endoscopic retrograde cholangiopancreatography nasobiliary tube stent

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