Copyright
©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Evaluation of novel slim biopsy forceps for diagnosis of biliary strictures: Single-institutional study of consecutive 360 cases (with video)
Kenjiro Yamamoto, Takayoshi Tsuchiya, Takao Itoi, Shujiro Tsuji, Reina Tanaka, Ryosuke Tonozuka, Mitsuyoshi Honjo, Shuntaro Mukai, Kentaro Kamada, Mitsuru Fujita, Yasutsugu Asai, Yukitoshi Matsunami, Yuichi Nagakawa, Hiroshi Yamaguchi, Atsushi Sofuni
Kenjiro Yamamoto, Takayoshi Tsuchiya, Takao Itoi, Shujiro Tsuji, Reina Tanaka, Ryosuke Tonozuka, Mitsuyoshi Honjo, Shuntaro Mukai, Kentaro Kamada, Mitsuru Fujita, Yasutsugu Asai, Yukitoshi Matsunami, Atsushi Sofuni, Department of Gastroenterology and Hepatology, Tokyo Medical University, Shinjuku-ku, Tokyo 160-0023, Japan
Yuichi Nagakawa, Third Department of Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo 160-0023, Japan
Hiroshi Yamaguchi, Department of Pathology, Tokyo Medical University, Shinjuku-ku, Tokyo 160-0023, Japan
Author contributions: Yamamoto K, Tsuchiya T and Itoi T contributed equally to this work; Yamamoto K, Tsuchiya T, Itoi T, Tsuji S, Tanaka R, Tonozuka R, Honjo M, Mukai S, Kamada K, Fujita M, Asai Y, Matsunami Y, Nagakawa Y and Sofuni A performed the research and collected the data; Yamamoto K, Tsuchiya T, Itoi T and Sofuni A reviewed the data analysis; Yamaguchi H reviewed all pathological specimens.
Institutional review board statement: This study was reviewed and approved by our institutional review board (Tokyo Medical University No. 3516).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. For full disclosure, the details of the study are published on the home page of Tokyo Medical University.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Takao Itoi, MD, PhD, FACG, FASGE, Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan. itoi@tokyo-med.ac.jp
Telephone: +81-3-33426111 Fax: +81-3-53816654
Received: March 18, 2017
Peer-review started: March 20, 2017
First decision: June 8, 2017
Revised: July 16, 2017
Accepted: August 2, 2017
Article in press: August 2, 2017
Published online: September 21, 2017
AIM
To evaluate the feasibility and reliability of endoscopic transpapillary bile duct biopsy for the diagnosis of biliary strictures.
METHODS
A total of 360 patients (241 men) who underwent endoscopic retrograde cholangiopancreatography for biliary strictures with biopsy from April 2012 to March 2016 at Tokyo Medical University Hospital were retrospectively reviewed. This study was approved by our Institutional Review Board (No. 3516). Informed consent was obtained from all individual participants included in this study. The biopsy specimens were obtained using a novel slim biopsy forceps (Radial Jaw 4P, Boston Scientific, Boston, MA, United States).
RESULTS
The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 69.6%, 100%, 100%, 59.1%, and 78.8%, respectively. The sensitivity was 75.6% in bile duct cancer, 64% in pancreatic cancer, 61.1% in gallbladder cancer, and 57.1% in metastasis. In bile duct cancer, a lower sensitivity was observed for perihilar bile duct stricture (68.7%) than for distal bile duct stricture (83.1%). In terms of the stricture lengths of pancreatic cancer, gallbladder cancer, and metastasis, a longer stenosis resulted in a better sensitivity. In particular, there was a significant difference between pancreatic cancer and gallbladder cancer (P < 0.05). One major complication was perforation of the extrahepatic bile duct with bile leakage.
CONCLUSION
Endoscopic transpapillary biopsy alone using novel slim biopsy forceps is feasible and reliable, but restrictive. Biopsy should be performed in consideration of the stricture level, stricture length, and cancer type.
Core tip: Various radiological imaging procedures have been established as first-line modalities for detecting biliary strictures. However, a definitive diagnosis of biliary strictures can only be established by histocytological examination. At present, there are several histocytological sampling techniques such as aspiration cytology, brush cytology, aspiration needle biopsy, and forceps biopsy. However, the optimal sampling technique remains controversial. In this study, we found that transpapillary biopsy was feasible and reliable for diagnosing biliary strictures and should be performed in consideration of the stricture level, stricture length, and cancer type.
