Published online May 16, 2022. doi: 10.4253/wjge.v14.i5.291
Peer-review started: July 2, 2021
First decision: January 10, 2022
Revised: January 22, 2022
Accepted: April 21, 2022
Article in press: April 21, 2022
Published online: May 16, 2022
The differential diagnosis between benign and malignant biliary strictures is challenging and requires a multidisciplinary approach with the use of serum biomarkers, imaging techniques, and several modalities of endoscopic or percutaneous tissue sampling. The diagnosis of biliary strictures consists of laboratory markers, and invasive and non-invasive imaging examinations such as computed tomography (CT), contrast-enhanced magnetic resonance cholangiopancreatography, and endoscopic ultrasonography (EUS). Nevertheless, invasive imaging modalities combined with tissue sampling are usually required to confirm the diagnosis of suspected malignant biliary strictures, while pathological diagnosis is mandatory to decide the optimal therapeutic strategy. Although EUS-guided fine-needle aspiration biopsy is currently the standard procedure for tissue sampling of solid pancreatic mass lesions, its diagnostic value in intraductal infiltrating type of cholangiocarcinoma remains limited. Moreover, the “endobiliary approach” using novel slim biopsy forceps, transpapillary and percutaneous cholangioscopy, and intraductal ultrasound-guided biopsy, is gaining ground on traditional endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography endobiliary forceps biopsy. This review focuses on the available endobiliary techniques currently used to perform biliary strictures biopsy, comparing the diagnostic performance of endoscopic and percutaneous approaches.
Core Tip: Invasive imaging modalities combined with tissue sampling are almost always required to confirm the diagnosis of suspected malignant biliary strictures. The “endobiliary approach” using novel slim biopsy forceps, transpapillary and percutaneous cholangioscopy, and intraductal ultrasound-guided biopsy is gaining ground over traditional endoscopic retrograde cholangiopancreatography and percutaneous endobiliary forceps biopsy. Nevertheless, both endoscopic and percutaneous interventional radiology modalities are today considered safe and effective tissue sampling options, providing histologic identification of biliary strictures with satisfactory sensitivity and specificity rates.