Victor DW, Sherman S, Karakan T, Khashab MA. Current endoscopic approach to indeterminate biliary strictures. World J Gastroenterol 2012; 18(43): 6197-6205 [PMID: 23180939 DOI: 10.3748/wjg.v18.i43.6197]
Corresponding Author of This Article
Mouen A Khashab, MD, Assistant Professor, Department of Medicine, Johns Hopkins Hospital, 1830 E. Monument Street, Room 424, Baltimore, MD 21205, United States. mkhasha1@jhmi.edu
Article-Type of This Article
Guidelines For Clinical Practice
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World J Gastroenterol. Nov 21, 2012; 18(43): 6197-6205 Published online Nov 21, 2012. doi: 10.3748/wjg.v18.i43.6197
Current endoscopic approach to indeterminate biliary strictures
David W Victor, Stuart Sherman, Tarkan Karakan, Mouen A Khashab
David W Victor, Mouen A Khashab, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD 21287, United States
Stuart Sherman, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States
Tarkan Karakan, Department of Medicine, Gazi University, 06710 Ankara, Turkey
Author contributions: Khashab MA, Victor DW, Karakan T and Sherman S designed the manuscript; Khashab MA and Victor DW drafted the article; Khashab MA, Victor DW, Karakan T and Sherman S revised the article.
Correspondence to: Mouen A Khashab, MD, Assistant Professor, Department of Medicine, Johns Hopkins Hospital, 1830 E. Monument Street, Room 424, Baltimore, MD 21205, United States. mkhasha1@jhmi.edu
Telephone: +1-443-2871960 Fax: +1-410-5020198
Received: April 18, 2012 Revised: July 6, 2012 Accepted: July 18, 2012 Published online: November 21, 2012
Abstract
Biliary strictures are considered indeterminate when basic work-up, including transabdominal imaging and endoscopic retrograde cholangiopancreatography with routine cytologic brushing, are non-diagnostic. Indeterminate biliary strictures can easily be mischaracterized which may dramatically affect patient’s outcome. Early and accurate diagnosis of malignancy impacts not only a patient’s candidacy for surgery, but also potential timely targeted chemotherapies. A significant portion of patients with indeterminate biliary strictures have benign disease and accurate diagnosis is, thus, paramount to avoid unnecessary surgery. Current sampling strategies have suboptimal accuracy for the diagnosis of malignancy. Emerging data on other diagnostic modalities, such as ancillary cytology techniques, single operator cholangioscopy, and endoscopic ultrasonography-guided fine needle aspiration, revealed promising results with much improved sensitivity.
