Su1379 A Systematic Approach to Standard Endoscopic Sampling of Bile Duct Strictures Is Highly Accurate in the Diagnosis of Peri-Hilar Cholangiocarcinoma. A Single UK Tertiary Centre Experience

A Systematic Approach to Standard Endoscopic Sampling of Bile Duct Strictures Is Highly Accurate in the Diagnosis of Peri-Hilar Cholangiocarcinoma. A Single UK Tertiary Centre Experience Omar Noorullah*, Christopher A. Wadsworth, Katherine Brougham, Venkata P. Lekharaju, Stephen V. Hood, Nick Stern, Charalampos Kaltsidis, Monica Terlizzo, Richard Sturgess Digestive diseases unit, Aintree University Hospital, Liverpool, United Kingdom; Department of Pathology, Aintree University Hospital, Liverpool, United Kingdom Background: Biliary tract cancers carry a poor prognosis. Early and accurate diagnosis is imperative but has traditionally been difficult. The commonest method to obtain tissue or cytology from biliary stricture is at ERCP which is quite often a therapeutic procedure in the same setting. Various techniques have been used with widely varying and mostly modest results, sensitivity of 11-79% for retrieved stent examination, 6-30% for bile aspirate cytology, 33-57% for brush cytology and 43-81% for transpapillary histology. The yield may be increased by combining at least two sampling methods. Ancillary cytology techniques like FISH and DIA have shown to improve yield but have somewhat less specificity. Aims: To determine the yield of a systematic protocol of transpapillary biopsy and brush cytology in diagnosing malignant biliary strictures. Methods: Data was collected prospectively on all patients referred for management of bile duct strictures who underwent histology and cytology in the same setting. Ampullary tumours and patients undergoing cholangioscopic sampling were excluded. The median length of follow up was 20 months (range 4-35). Histology was obtained before cytology. Following sphincterotomy, transpapillary biopsies were obtained using a paediatric (2.0mm) biopsy forceps (Boston Scientific, Radial Jaw 4 paediatric biopsy forceps, Hemel Hempstead, UK). Fluoroscopic guidance was used to adjust intraductal position and to selectively target the stricture. A minimum of 4 biopsies were obtained. A meticulous protocol was followed for obtaining cytology, using an over the wire, 2.1mm brush (Boston Scientific, RX Biliary brush 2.1mm, Hemel Hempstead, UK). This involved multiple passes through the stricture and withdrawal of the brush in to the catheter following the final pass. On retrieval, the catheter was flushed with the cytology fixation fluid in to the cytology collection container and the brush was cut off and sent in the same container. The sample was delivered to the lab for processing to the lab immediately after the procedure. Results: See table 1 and table 2. Also, 26 benign strictures were sampled. There were no false positives. No complications as direct result of either tissue acquisition techniques occurred. Discussion: A highly systematic approach to biliary stricture sampling has shown excellent performance in particular for hilar strictures. Combination of histology and cytology offers a significant advantage in accurate diagnosis. The high yield on cytology in our study may reflect attention to technique, exfoliation of malignant cells when obtaining biopsies earlier or prompt processing in the lab. None of the techniques adopted required specialised equipment or skills and could be adopted by any ERC unit. Table 1.