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World J Gastrointest Endosc. May 16, 2022; 14(5): 291-301
Published online May 16, 2022. doi: 10.4253/wjge.v14.i5.291
Endobiliary biopsy
Riccardo Inchingolo, Fabrizio Acquafredda, Alessandro Posa, Thiago Franchi Nunes, Stavros Spiliopoulos, Francesco Panzera, Carlos Alberto Praticò
Riccardo Inchingolo, Fabrizio Acquafredda, Interventional Radiology Unit, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Italy
Alessandro Posa, Department of Radiology, Policlinico Universitario “A. Gemelli“, Rome 00186, Italy
Thiago Franchi Nunes, Interventional Radiology Unit, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, Brazil
Stavros Spiliopoulos, 2nd Department of Radiology, Interventional Radiology Unit, National and Kapodistrian University of Athens, Athens 12461, Greece
Francesco Panzera, Interventional Gastroenterology Unit, Madonna Delle Grazie Hospital, Matera 75100, Italy
Carlos Alberto Praticò, Unité d’Endoscopie Digestive, Hôpital Privé “Armand Brillard” 3/5 avenue Watteau, Nogent-sur-Marne 94130, France
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting, critical revision, and editing of the manuscript, and final approval of the final version.
Conflict-of-interest statement: All the authors are aware of the content of the manuscript and have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Riccardo Inchingolo, MD, Chief Doctor, Director, Doctor, Interventional Radiology Unit, "F. Miulli" General Regional Hospital, strada per santeramo, Acquaviva delle Fonti 70021, Italy. riccardoin@hotmail.it
Received: July 2, 2021
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
Processing time: 317 Days and 18.1 Hours
Abstract

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.

Keywords: Biliary strictures; Endoscopic retrograde cholangiography; Cholangioscopy; Endobiliary forceps biopsy; Intraductal ultrasound-guided biopsy; Percutaneous transhepatic

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.