Complete tissue sampling of biliary strictures at ERCP using a new device☆,☆☆,★,★★
Section snippets
MATERIALS AND METHODS
The new device consists of a clear-walled Teflon 10F double-lumen catheter with a tapered and reinforced tip. From the distal tip, a 0.035-inch guide wire channel permits placement over a standard working guide wire. The second channel is 5F in diameter and is fitted with a 45-degree angle radiopaque ramp with a biopsy port positioned one centimeter below the shoulder of the dilator. The device is furnished with a 22 gauge biopsy needle mounted in a 3F metal ball-tipped catheter (Fig. 1).
RESULTS
Results are summarized in Table 1. Needle biopsies were positive in 15% and highly suspicious in 12%. Forceps biopsies were positive in 15% and suspicious in 15%. Finally, brush cytologies were positive in 42% and highly suspicious in 15%. Combining these yields, 18 of the 26 patients (69%) with malignant strictures had at least one positive or highly suspicious test. No positive results were seen in the two patients with benign strictures, making the test specificities 100%. All three
DISCUSSION
Endoscopists have grown to expect a positive diagnosis in sampling mucosal lesions from the upper and lower gastrointestinal tract in greater than 90% of patients. Although tissue sampling techniques have been available since the very inception of sphincterotomy, they remain rarely used with the possible exception of brush cytology. Because of the extrinsic and frequently desmoplastic nature of pancreaticobiliary malignancies, yields of single techniques have been disappointing, and collection
Acknowledgements
The authors thank Bill Sweeney, Bruce McBrien, and the staff at Wilson-Cook Medical, Inc., who supplied technical help in developing this device. At present, the authors have no agreement relating to this device which would provide financial benefit and no patent application has been submitted. There exists no consulting agreement between Wilson-Cook and any of the authors.
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Cited by (0)
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From the Division of Gastroenterology and Department of Pathology, Maine Medical Center, Portland, Maine.
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Dr. Bosco's current address: Lahey Clinic Foundation, Burlington, Mass.
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Reprint requests: Douglas A. Howell, MD, 131 Chadwick Street, Portland, Maine 04102.
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37/69/68723