Cholangioscope-directed forceps biopsies have a much higher sensitivity in most reports, but are usually negative in some cases of sclerosing-type cholangiocarcinoma. EUS-FNA is the best method for cytologic diagnosis of distal tumors, however for proximal tumors, specially those that are not mass-forming, traditionally the sensitivity is much lower Methods: As part of a prospective study to compare methods for the diagnosis of indeterminate biliary strictures in a stepwise-fashion, EUS-FNA
is performed initially when technically feasible, followed by ERCP with brushings and cholangioscopy with forceps biopsies. Only when FNA is inadequate or unknown during the procedure (no cytologist present), the other procedures are performed selleck during ERCP. Results: 42 patients have been included, of which 19 had proximal strictures. Of these, EUS-FNA was performed in 17 with a 94% sensitivity (in two it was technically impossible, for brush cytology the sensitivity was 55% (5/9) and 30% for cholangioscopy directed biopsies (2/6). 18 tumors were of the sclerosing, non-mass forming type, seen by EUS only as diffuse thickening of the wall and no intralumenal mass bu cholangioscopy. Conclusion: An approach MK2206 starting with EUS-FNA seems highly sensitive in cases of non-mass forming proximal strictures and obviates the need for other procedures; this is a change in the traditional IKBKE paradigm
in these patients. Key Word(s): 1. cholangiocarcinoma; 2. EUS-FNA; 3. cholangioscopy; 4. cytology; Presenting Author: HUIJER HWANG Additional Authors: RAUL MATANO, MARTIN GUIDI, JULIO DE MARIA, ESTEBAN PROMENZIO, FERNANDO RAGONE, JUAN VISCARDI Corresponding Author: HUIJER HWANG Affiliations: El Cruce Hospital Objective: Approximately 10-15% of the choledocal stones extraction can be difficult with ERCP conventional sphincterotomy. In the past decade it has begun to use a new technique combining sphincterotomy with large balloon dilation of 12-20 mm in diameter in such cases: larger than 20 mm stones extraction , multiple stones, large periampullary diverticulum and / or thin distal common bile duct.
Several studies have demonstrated increased therapeutic efficacy and lower complication rates. Aim:To compare the effectiveness and complications of sphincterotomy followed by large balloon dilation with sphincterotomy alone in the management of difficult bile duct stones (giants and / or multiple calculies). Methods: A retrospective comparative analysis of managing difficult stones (stones > 20 mm in diameter and / or multiple) by ERCP for 26 months. Comparison of the first treatment with conventional ERCP between sphincterotomy (group A) and sphincterotomy plus large balloon dilation (group B) was made, and the following variables were analized: procedural success, successful complete removal of the stones, use of mechanical lithotripsy and complications.