Tabibian JH, Visrodia KH, Levy MJ, Gostout CJ. Advanced endoscopic imaging of indeterminate biliary strictures. World J Gastrointest Endosc 2015; 7(18): 1268-1278 [PMID: 26675379 DOI: 10.4253/wjge.v7.i18.1268]
Corresponding Author of This Article
Dr. Christopher J Gostout, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, United States. gostout.christopher@mayo.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Dec 10, 2015; 7(18): 1268-1278 Published online Dec 10, 2015. doi: 10.4253/wjge.v7.i18.1268
Advanced endoscopic imaging of indeterminate biliary strictures
James H Tabibian, Kavel H Visrodia, Michael J Levy, Christopher J Gostout
James H Tabibian, Michael J Levy, Christopher J Gostout, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
James H Tabibian, Division of Gastroenterology, Wilmott Center for Endoscopic Innovation, Research, and Training, University of Pennsylvania, Philadelphia, PA 19104, United States
Kavel H Visrodia, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Tabibian JH and Visrodia KH contributed equally to this work; Tabibian JH and Visrodia KH performed the literature review for relevant content; Tabibian JH and Visrodia KH composed a first draft; Levy MJ and Gostout CJ provided supervision and critical revisions of the manuscript; all authors approved of the manuscript.
Conflict-of-interest statement: Dr. Gostout is a consultant for, and conducts research sponsored by, Olympus Medical Systems.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Christopher J Gostout, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, United States. gostout.christopher@mayo.edu
Telephone: +1-507-2841649
Received: May 25, 2015 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
Abstract
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.
