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Background/aims: Brush cytology during ERCP has been reported to have a low sensitivity. A new device, Howell biliary system (Wilson-Cook), enables targeted biopsies for histopathologic assessment. The aim was to compare histopathology with brush cytology., Methodology: Brush cytology followed by biopsies obtained by the Howell device was taken consecutively from bile duct strictures. Coded slides were scored by 3 pathologists and 2 cytologists in a 3-graded scale; 2: benign; 3: suspicious of malignancy; 4: malignant. The clinical outcome including autopsy served as the gold standard for the definite diagnoses., Results: Twenty-one malignant and 6 benign strictures were evaluated. The histopathology revealed 11 out of the 21 malignant as certain or suspected malignant (score > or = 3) (sensitivity: 0.52). The cytology scored 17 out of 21 > or = 3 (sensitivity: 0.80). The in pair kappa values for the 3 pathologists were: (0.37; 0.26; 0.41) vs. 0.56 for the 2 cytologists. Among the evaluable strictures the pathologists scorings were; (median: 3.0, SD: 0.72) for the malignant and (median: 2.3, SD: 0.98) for the benign (p = 0.27) and the cytology scorings were; (median: 3.5, SD: 0.73) for the malignant and (median: 2.7, SD: 0.65) for the benign (p = 0.09)., Conclusions: Brush cytology has a higher accuracy than the targeted biopsies and should be used in combination with other methods to reach the correct diagnosis.

Endometriosis is a common disease occurring in about 10% of all women. Involvement of the gastrointestinal tract is not infrequent and endometriosis should therefore be considered in the differential diagnosis of colon lesions in women of childbearing and middle age. Colorectal endometriosis may cause obstructing symptoms difficult to distinguish from malignant or inflammatory disease, as is demonstrated by 6 case reports. Colorectal endometriosis is mostly localized to the sigmoid or the anterior rectal wall with extramucosal radiologic appearance and is difficult to diagnose by sigmoidoscopy. Patients with an infiltration of the anterior rectal wall (shelf tumour) should undergo a complete evaluation including laparoscopy before surgery is considered. Bowel resection often offers the best chance of cure.