Department of Gastroenterology and Hepatology, Tokyo Medical University, Shinjuku-ku, Tokyo 160-0023, Japan.
Third Department of Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo 160-0023, Japan.
World J Gastroenterol. 2017 Sep 21;23(35):6429-6436. doi: 10.3748/wjg.v23.i35.6429.
To evaluate the feasibility and reliability of endoscopic transpapillary bile duct biopsy for the diagnosis of biliary strictures.
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).
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 ( < 0.05). One major complication was perforation of the extrahepatic bile duct with bile leakage.
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.
评估经内镜逆行胰胆管造影（ERCP）下经乳头胆管活检诊断胆道狭窄的可行性和可靠性。
回顾性分析 2012 年 4 月至 2016 年 3 月期间在东京医科大学医院因胆道狭窄行 ERCP 并进行活检的 360 例（男 241 例）患者的临床资料。本研究经我院伦理委员会批准（编号 3516），所有入组患者均签署了知情同意书。活检标本采用新型细径活检钳（Radial Jaw 4P，Boston Scientific，Boston，MA，美国）获取。
诊断胆道狭窄的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为 69.6%、100%、100%、59.1%和 78.8%。胆管癌、胰腺癌、胆囊癌和转移癌的敏感度分别为 75.6%、64%、61.1%和 57.1%。肝门部胆管狭窄的敏感度（68.7%）低于远段胆管狭窄（83.1%）。胰腺癌、胆囊癌和转移癌狭窄长度较长时敏感度较高，且差异有统计学意义（<0.05）。主要并发症为肝外胆管穿孔伴胆汁漏。
新型细径活检钳经内镜逆行胰胆管造影下经乳头胆管活检是一种可行且可靠的方法，但存在一定的局限性。应根据狭窄部位、长度和肿瘤类型来决定是否进行活检。
