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Current Treatment Options in Gastroenterology
Published in: Current Treatment Options in Gastroenterology 2/2021

01-06-2021 | Ultrasound | Endoscopy (P Siersema, Section Editor)

Endoscopic Evaluation of Indeterminate Biliary Strictures: a Review

Authors: Dominic Staudenmann, MBBS (hons), FRACP, Mark Bonnichsen, MBBS (hons), FRACP, Payal Saxena, MBBS (hons) BE (hons) M Biomed E, FRACP, Arthur John Kaffes, MBBS (hons), FRACP

Published in: Current Treatment Options in Gastroenterology | Issue 2/2021

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Abstract

Purpose of review

Indeterminate biliary strictures present a balancing act between the potential morbidity from redundant operations and the risk of missed malignancy and disease progression. This review aims to compare and assess the efficacy of the different diagnostic techniques.

Recent findings

Until today, endoscopic retrograde cholangiopancreatography with tissue sampling was considered the standard for distinguishing benign from malignant biliary strictures. However, it is hampered by a low diagnostic yield.

Summary

Indeterminate biliary strictures remain a difficult clinical problem. Invariably, expert evaluation and review at an MDT setting should be the first step. If the diagnosis remains elusive despite the initial strategies including clinical evaluation, imaging with CT or MRI and initial sampling with either EUS or ERCP brushing, the patient should then be considered for expert IDBS evaluation. These patients should be selected for cholangioscopy with direct visualisation, direct sampling and, if available, advanced interpretive techniques such as confocal laser endomicroscopy and FISH etc. These techniques can assist in improving diagnosis and minimise delay to essential treatment and avoid unnecessary surgery. PSC remains a challenge; however, recent advances in cholangioscopy classification are proving useful in managing this cohort.
Appendix
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Metadata
Title
Endoscopic Evaluation of Indeterminate Biliary Strictures: a Review
Authors
Dominic Staudenmann, MBBS (hons), FRACP
Mark Bonnichsen, MBBS (hons), FRACP
Payal Saxena, MBBS (hons) BE (hons) M Biomed E, FRACP
Arthur John Kaffes, MBBS (hons), FRACP
Publication date
01-06-2021

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