Published online Dec 10, 2015. doi: 10.4253/wjge.v7.i18.1268
Peer-review started: May 26, 2015
First decision: July 3, 2015
Revised: August 26, 2015
Accepted: October 20, 2015
Article in press: October 27, 2015
Published online: December 10, 2015
Processing time: 196 Days and 1.6 Hours
Endoscopic evaluation of indeterminate biliary strictures (IDBSs) has evolved considerably since the development of flexible fiberoptic endoscopes over 50 years ago. Endoscopic retrograde cholangiography pancreatography (ERCP) was introduced nearly a decade later and has since become the mainstay of therapy for relieving obstruction of the biliary tract. However, longstanding methods of ERCP-guided tissue acquisition (i.e., biliary brushings for cytology and intraductal forceps biopsy for histology) have demonstrated disappointing performance characteristics in distinguishing malignant from benign etiologies of IDBSs. The limitations of these methods have thus helped drive the search for novel techniques to enhance the evaluation of IDBSs and thereby improve diagnosis and clinical care. These modalities include, but are not limited to, endoscopic ultrasound, intraductal ultrasound, cholangioscopy, confocal endomicroscopy, and optical coherence tomography. In this review, we discuss established and emerging options in the evaluation of IDBSs.
Core tip: Indeterminate biliary strictures (IDBSs) remain a considerable challenge for endoscopists, clinicians, surgeons, and other medical professionals as well as patients. The limitations of current technologies have helped drive the search for novel techniques aimed to enhance the evaluation of IDBSs and thus improve diagnosis and clinical care. Here we review existing and emerging techniques and provide a synopsis of current understanding of their strengths, limitations, and role in the evaluation of IDBSs.