Manik Aggarwal, MBBS, Eric J. Vargas, MD, MS, John Martin, MD, Ryan J. Law, DO, Aliana Bofill-Garcia, MD, Bret Petersen, MD, Andrew Storm, MD, Barham Abu Dayyeh, MD, MPH, Vinay Chandrasekhara, MD Mayo Clinic, Rochester, MN
Introduction: The optimal modality and biliary sampling strategy with endoscopic retrograde cholangio-pancreatography (ERCP) remains unknown. This prospective study aimed to describe the practice patterns and compare diagnostic performance of different sampling techniques for evaluation of biliary strictures.
Methods: Patients undergoing ERCP-guided tissue sampling for biliary strictures from Oct 20-Feb 22 were prospectively enrolled (NCT04572711). Sampling modalities, order and combination of techniques (e.g., brush, biopsy and dilation) were chosen based on preference of the endoscopist. Brushings were performed with the aim of sampling across the entire length of the stricture by performing 20 motions of the cytology brush.Cytology results obtained after different sampling techniques were reported per existing guidelines. Malignant cytology was considered positive whereas negative, atypical, suspicious or insufficient cytology were considered negative. Final diagnosis of malignancy was confirmed by either histopathology or by suggestive clinical course with at least 12 months' follow-up. Diagnostic performance (sensitivity, specificity, and likelihood ratios [LR]) of different sampling techniques were reported against the final diagnosis of malignancy. Sensitivity and specificity are presented as percentages (with specified Clopper-Pearson (95% confidence limits [CI]), positive and negative LR are presented as point estimate.
Results: The final cohort included 351 patients, 139 (39.6%) had co-existent primary sclerosing cholangitis and malignancy was diagnosed in 108 (30.8%) patients. Stricture dilation and tissue biopsy were performed in 225 (64.1%) and 112 (31.9%) patients respectively. Overall sensitivity and specificity of ERCP guided biliary sampling was 15.3% (95% CI 3.8-23.4%) and 100% (95% CI 98.4-100%) respectively. Diagnostic performance was similar amongst different sampling techniques (Table 1). The order or combination of techniques did not impact sampling performance. A subgroup analysis of patients with perihilar strictures (n=225) demonstrated similar performance of various sampling techniques in different orders and combinations (Table 1).
Discussion: In this prospective cohort of patients with biliary strictures, diagnostic performance of different sampling techniques was similar and did not differ based on the order or number of techniques performed.
Disclosures:
Manik Aggarwal indicated no relevant financial relationships.
Eric J. Vargas: Philips – Grant/Research Support.
John Martin indicated no relevant financial relationships.
Ryan J. Law: boston scientific – Consultant. conmed – Consultant. medtronic – Consultant. uptodate – Royalties.
Aliana Bofill-Garcia indicated no relevant financial relationships.
Manik Aggarwal, MBBS, Eric J. Vargas, MD, MS, John Martin, MD, Ryan J. Law, DO, Aliana Bofill-Garcia, MD, Bret Petersen, MD, Andrew Storm, MD, Barham Abu Dayyeh, MD, MPH, Vinay Chandrasekhara, MD. P2880 - Prospective Evaluation of Practice Patterns and Diagnostic Performance of Sampling Techniques for Diagnosis of Malignant Biliary Strictures, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.