Shanghai, China.
Bucheon, Korea.
Aliment Pharmacol Ther. 2018 Jul;48(2):138-151. doi: 10.1111/apt.14811. Epub 2018 Jun 7.
Pre-operative tissue diagnosis for suspected malignant biliary strictures remains challenging.
To develop evidence-based consensus statements on endoscopic tissue acquisition for biliary strictures.
The initial draft of statements was prepared following a systematic literature review. A committee of 20 experts from Asia-Pacific region then reviewed, discussed, and modified the statements. Two rounds of independent voting were conducted to reach a final version. Consensus was considered to be achieved when 80% or more of voting members voted "agree completely" or "agree with some reservation."
Eleven statements achieved consensus. The choice of tissue sampling modalities for biliary strictures depends on the clinical setting, the location of lesion, and availability of expertise. Detailed radiological and endoscopic evaluation is useful to guide the selection of appropriate tissue acquisition technique. Standard intraductal biliary brushing and/or forceps biopsy is the first option when endoscopic biliary drainage is required with an overall (range) sensitivity and specificity of 45% (26%-72%) and 99% (98%-100%), and 48% (15%-100%) and 99% (97%-100%), respectively, in diagnosing malignant biliary strictures. Probe-based confocal laser endomicroscopy and fluorescence in situ hybridisation using 4 fluorescent-labelled probes targeting chromosomes 3, 7, 17 and 9p21 locus may be added to improve the diagnostic yield. Cholangioscopy-guided biopsy and EUS-guided tissue acquisition can be considered after prior negative conventional tissue sampling with an overall (range) sensitivity and specificity of 60% (38%-88%) and 98% (83%-100%), and 80% (46%-100%) and 97% (92%-100%), respectively, in diagnosing malignant biliary strictures.
These consensus statements provide evidence-based recommendations for endoscopic tissue acquisition of biliary strictures.
术前对疑似恶性胆道狭窄进行组织诊断仍然具有挑战性。
就胆道狭窄的内镜下组织获取制定基于证据的共识声明。
采用系统文献回顾制定声明初稿。然后，来自亚太地区的 20 名专家组成委员会对声明进行审查、讨论和修改。进行了两轮独立投票，以达成最终版本。当 80%或更多的投票成员投票“完全同意”或“有保留地同意”时，即达成共识。
11 项声明达成共识。胆道狭窄的组织采样方式选择取决于临床情况、病变位置和专业知识的可用性。详细的影像学和内镜评估有助于指导选择合适的组织采集技术。当需要进行内镜下胆道引流且整体（范围）敏感性和特异性分别为 45%（26%-72%）和 99%（98%-100%），48%（15%-100%）和 99%（97%-100%）时，标准的经内镜胆管刷检和/或活检钳活检是首选方法，用于诊断恶性胆道狭窄。在这种情况下，可添加基于探头的共聚焦激光内镜检查和使用针对染色体 3、7、17 和 9p21 位的 4 种荧光标记探针的荧光原位杂交技术，以提高诊断率。在先前进行的常规组织采样为阴性后，可考虑进行胆管镜引导下活检和 EUS 引导下组织获取，整体（范围）敏感性和特异性分别为 60%（38%-88%）和 98%（83%-100%），80%（46%-100%）和 97%（92%-100%），用于诊断恶性胆道狭窄。
这些共识声明为胆道狭窄的内镜下组织获取提供了基于证据的建议。
