Appropriate number of biliary biopsies and endoscopic retrograde cholangiopancreatography sessions for diagnosing biliary tract cancer

doi:10.4253/wjge.v11.i3.231

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World Journal of Gastrointestinal Endoscopy

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World J Gastrointest Endosc. Mar 16, 2019; 11(3): 231-238
Published online Mar 16, 2019. doi: 10.4253/wjge.v11.i3.231

Appropriate number of biliary biopsies and endoscopic retrograde cholangiopancreatography sessions for diagnosing biliary tract cancer

Tadayuki Takagi, Mitsuru Sugimoto, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Ko Watanabe, Jun Nakamura, Hitomi Kikuchi, Mika Takasumi, Minami Hashimoto, Takuto Hikichi, Hiromasa Ohira

Tadayuki Takagi, Mitsuru Sugimoto, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Ko Watanabe, Jun Nakamura, Hitomi Kikuchi, Mika Takasumi, Minami Hashimoto, Hiromasa Ohira, Department of Gastroenterology, Fukushima Medical University, School of Medicine, Fukushima 960-1247, Japan

Ko Watanabe, Jun Nakamura, Hitomi Kikuchi, Minami Hashimoto, Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1247, Japan

Author contributions: Takagi T and Sugimoto M designed and performed the study; Takagi T, Sugimoto M and Ohira H analyzed the data and wrote the paper; Suzuki R, Konno N, Asama H, Watanabe K, Nakamura J, Kikuchi H, Takasumi M, Sato Y, Hashimoto M and Hikichi T provided clinical advice; and Hikichi T and Ohira H supervised the study.

Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Fukushima Medical University.

Informed consent statement: Patients were not required to give informed consent for participation in the study because the analysis used anonymous clinical data obtained after each patient provided written consent agreeing to treatment. For full disclosure, the details of the study are published on the home page of Fukushima Medical University.

Conflict-of-interest statement: We have no financial relationships to disclose.

Data sharing statement: No additional data are available.

Corresponding author: Mitsuru Sugimoto, MD, PhD, Assistant Professor, Department of Gastroenterology, Fukushima Medical University, School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima Prefecture, Fukushima 960-1247, Japan. kita335@fmu.ac.jp

Telephone: +81-24-5471202 Fax: +81-24-5472055

Received: January 26, 2019
Peer-review started: January 27, 2019
First decision: February 20, 2019
Revised: February 28, 2019
Accepted: March 11, 2019
Article in press: March 11, 2019
Published online: March 16, 2019
Processing time: 49 Days and 16.6 Hours

Abstract

BACKGROUND

Biliary ductal cancer (BDC) is a lethal disease; however, diagnosing BDC is challenging. Biliary biopsies are performed to pathologically diagnose BDC, but the appropriate parameters for biliary biopsy [number of biliary biopsies, number of endoscopic retrograde cholangiopancreatography (ERCP) sessions, etc.] are unknown.

AIM

To clarify what constitutes an adequate method for biliary biopsy.

METHODS

In total, 95 patients who underwent endoscopic biliary biopsy without choledochoscopy and who were pathologically diagnosed with BDC were enrolled in this study. The patients were divided into two groups. Seventy-six patients who were diagnosed by biliary biopsy were defined as the positive group (P group), and nineteen patients who were not diagnosed by biliary biopsy were defined as the negative group (N group). The patient characteristics and ERCP-related procedures were compared between the P and N groups.

RESULTS

The numbers of ERCP sessions and biliary biopsies were significantly different between the two groups [ERCP sessions (one/two), P group 72/4 vs N group 15/4, P value = 0.048; number of biliary biopsies, P group 2 (1-6) vs N group 2 (1-7), P value = 0.039]. In a multivariate analysis, fewer than 2 ERCP sessions was an independent factor influencing the positivity of the biliary biopsies.

CONCLUSION

This study clarified that ERCP and biliary ductal biopsy should only be performed once. If biliary cancer is not pathologically diagnosed after the first ERCP session, other methods (Endoscopic ultrasonography-guided fine needle aspiration or choledochoscopy-guided biliary ductal biopsy) should be employed.

Keywords: Biliary ductal cancer; Biliary biopsy; Endoscopic retrograde cholangiopancreatography; Endoscopic ultrasonography-guided fine needle aspiration; Choledochoscopy

Core tip: The appropriate parameters for biliary biopsy [number of biliary biopsies, number of endoscopic retrograde cholangiopancreatography (ERCP) sessions, etc.) are unknown. In this report, fewer than 2 ERCP sessions was an independent factor influencing the positivity of the biliary biopsies. If biliary cancer is not pathologically diagnosed after the first ERCP session, other methods (Endoscopic ultrasonography-guided fine needle aspiration or choledochoscopy-guided biliary ductal biopsy) should be employed.