Value of push-tube assisted biliary biopsy in endoscopic retrograde cholangiopancreatography to the diagnosis of malignant biliary strictures
Objective To observe the histopathological results of push-tube assisted biliary biopsy in endoscopic retrograde cholangiopancreatography(ERCP)and to investigate its value and safety in the diagnosis of malignant biliary strictures.Methods The clinical data of 104 patients with malignant biliary strictures in the First Affiliated Hospital of Yangtze University and the First Hospital of Lanzhou University from August 2017 to December 2022 were retrospectively analyzed,among whom 56 patients were performed ERCP push-tube assisted biliary biopsy(observation group)and 48 patients were performed SpyGlass cholangioscopy biopsy(control group).After biopsy,all patients were implanted biliary stents or received nasobiliary drainage.The occurrences of complications such as mild,moderate and severe pancreatitis,cholangitis,biliary bleeding and perforation within 48 h after surgery,as well as the histopathological results of bile duct biopsy tissue were recorded in two groups.Those with no definitive diagnosis by biliary biopsy were followed up for 6 months after surgery.The clinical diagnosis was made again on the basis of serum tumor markers,imaging examinations,second cholangioscopy biopsy and surgery results.The gender ratio,age,comorbidities(hypertension,diabetes,coronary heart disease,liver cirrhosis),site of strictures,rate of endoscopic sphincterotomy(EST),number of biopsy specimens,overall definitive diagnostic rate,definitive diagnostic rates of strictures in the hepatic hilum,upper middle part of the common bile duct and lower part of the common bile duct,and the detection rate of cholangiocarcinoma were compared between two groups.Results(1)The EST rate was lower in observation group(69.64％)than that in control group(100.00％)(x2=15.269,P＜0.001),the biopsy specimen was more in observation group[4(1,7)]than that in control group[3(1,6)](x2=3.325,P＜0.001),and there were no significant differences in the age,gender ratio,proportions of comorbidities(hypertension,diabetes,coronary heart disease,liver cirrhosis)and sites of strictures between two groups(P＞0.05).(2)A definitive diagnosis was made by biopsy in 47 patients(83.93％)in observation group,and 42(87.50％)in control group,with no significant difference in the definitive diagnostic rate between two groups(x2=0.267,P=0.605).There were no significant differences in the definite diagnostic rates of strictures at hepatic hilum,upper middle part of common bile duct,and lower part of common bile duct between observation group(76.47％,87.50％,86.67％)and control group(86.67％,94.45％,80.00％)(x2=0.527,P=0.659;x2=0.562,P=0.623;x2=0.232,P=0.500).(3)In observation group,48 patients were clinically diagnosed with cholangiocarcinoma,among whom 44(91.67％)were confirmed by biliary biopsy,while in control group,47 patients were clinically diagnosed with cholangiocarcinoma,among whom 42(89.36％)were confirmed by biliary biopsy,with no significant difference in the detection rate by biliary biopsy between two groups(x2=0.001,P=0.974).(4)No severe pancreatitis,biliary bleeding or perforation occurred in two groups.Postoperative complications occurred as mild pancreatitis in 3 patients,moderate pancreatitis in 1 patient and cholangitis in 2 patients in observation group,while mild pancreatitis in 2 patients,moderate pancreatitis in 2 patients and cholangitis in 5 patients in control group.There was no significant difference in the overall incidence rate of postoperative complications between observation group(10.71％)and control group(18.75％)(x2=1.352,P=0.245).Conclusion Push-tube assisted biliary biopsy in ERCP achieves similar diagnostic efficiency as SpyGlass cholangioscopy,and it can reduce intraoperative EST and increase no postoperative complications.
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