A novel method of forceps biopsy improves the diagnosis of proximal XXXX .

@entity5 @entity1 @entity157 @entity1086
BACKGROUND AND AIMS: Tissue specimen collection represents a cornerstone in diagnosis of proximal biliary tract malignancies offering great specificity, but only limited sensitivity. To improve the @entity5 detection rate, we developed a new method of forceps biopsy and compared it prospectively with endoscopic transpapillary brush cytology. @entity1 AND METHODS: 43 @entity1 with proximal biliary stenoses, which were suspect for @entity5 , undergoing endoscopic retrograde cholangiography were prospectively recruited and subjected to both biopsy [using a double-balloon enteroscopy (DBE) forceps under a guidance of a pusher and guiding catheter with guidewire] and transpapillary brush cytology. The cytological/histological findings were compared with the final clinical diagnosis. RESULTS: 35 out of 43 @entity1 had a malignant disease (33 cholangiocarcinomas, 1 @entity157 , 1 @entity1086 ). The sensitivity of cytology and biopsy in these @entity1 was 49 and 69%, respectively. The method with DBE forceps allowed a pinpoint biopsy of the biliary stenoses. Both methods had 100% specificity, and, when combined, 80% of malignant processes were detected. All @entity1 with non-malignant conditions were correctly assigned by both methods. No clinically relevant complications were observed. CONCLUSIONS: The combination of forceps biopsy and transpapillary brush cytology is safe and offers superior detection rates compared to both methods alone, and therefore represents a promising approach in evaluation of proximal biliary tract processes.
