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Current Gastroenterology Reports
Published in: Current Gastroenterology Reports 12/2020

01-12-2020 | Ultrasound | Endoscopy and Surgery (S Komanduri, Section Editor)

Determining the Indeterminate Biliary Stricture: Cholangioscopy and Beyond

Authors: Nichol S. Martinez, Arvind J. Trindade, Divyesh V. Sejpal

Published in: Current Gastroenterology Reports | Issue 12/2020

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Abstract

Purpose of Review

Indeterminate biliary strictures (IDBS) continue to be an area of frustration for clinicians. Standard endoscopic retrograde cholangiopancreatography (ERCP) with conventional brush cytology and/or forceps biopsy has a low sensitivity for distinguishing benign from malignant biliary strictures. A delay in diagnosis of malignancy has consequences for subsequent therapy or surgery. In this article, we review current and emerging technologies that may aid in this diagnostic dilemma.

Recent Findings

Several technologies have been utilized in IDBS to establish a diagnosis which include peroral cholangioscopy, confocal laser endomicroscopy, endoscopic ultrasound with fine needle aspiration, intraductal ultrasound, optical coherence tomography, fluorescence in situ hybridization, next generation sequencing, integrated molecular pathology, and DNA-image cytometry.

Summary

While cholangioscopy and confocal laser endomicroscopy have become standards of care in expert centers for the evaluation of patients with IDBS, there are several endoscopic and molecular modalities that may also aid in establishing a diagnosis. Further head-to-head prospective diagnostic studies as well as cost-efficacy studies are needed.
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Metadata
Title
Determining the Indeterminate Biliary Stricture: Cholangioscopy and Beyond
Authors
Nichol S. Martinez
Arvind J. Trindade
Divyesh V. Sejpal
Publication date
01-12-2020

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