Document Detail


Grasp or brush for biliary sampling at endoscopic retrograde cholangiography? A blinded randomized controlled trial.
MedLine Citation:
PMID:  17900324     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Brushing, the standard sampling method at endoscopic retrograde cholangiography (ERC), lacks sensitivity for cancer detection. We assessed a novel sampling method using a grasping basket. METHODS: Fifty-six patients with a suspected malignant biliary stricture were randomized to biliary sampling at ERC using a basket (basket group, N = 30) or a brush (brush group, N = 26), followed by the alternate device. When deemed necessary, strictures were dilated (using 6-mm balloons exclusively). The primary end point was sensitivity for cancer detection at cytopathological examination of the first sample collected in each patient; the cytopathologist was blinded to clinical details and sampling method. All analyses followed an intention-to-treat principle. RESULTS: All 56 patients had successful sampling with both techniques; 50 (89%) had a final diagnosis of malignant stricture. Sensitivity for cancer detection with the first sample collected in each patient was significantly higher in the basket compared to brush group (20/25 [80%]vs 12/25 [48%], respectively, P= 0.018, OR 4.33, 95% CI 1.24-15.21). Seventeen (34%) of the 50 sample pairs collected from malignant cases showed discordant cytopathological results: 15 patients had a positive basket and a negative brush result while two had the inverse association (P= 0.002, OR 7.5, 95% CI 1.65-47.44). Basketting more frequently yielded positive samples from malignant strictures in case of presampling balloon dilation (27/32 [84%]vs 10/18 [56%], respectively, P= 0.043, OR 4.32, 95% CI 1.14-16.37). Specificity was 100% (both methods). CONCLUSION: Biliary sampling at ERC using a dedicated basket provided a significantly higher sensitivity for cancer detection than brushing; presampling stricture dilation significantly increased sensitivity.
Authors:
Jean-Marc Dumonceau; Carlos Macias Gomez; Claudia Casco; Muriel Genevay; Mariano Marcolongo; Massimo Bongiovanni; Philippe Morel; Pietro Majno; Antoine Hadengue
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial     Date:  2007-09-25
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  103     ISSN:  0002-9270     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-02-21     Completed Date:  2008-04-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  333-40     Citation Subset:  IM    
Affiliation:
Service of Gastroenterology and Hepatology, Geneva University Hospitals, Geneva, Switzerland.
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MeSH Terms
Descriptor/Qualifier:
Aged
Bile Ducts / pathology*
Biopsy / instrumentation,  methods
Cholangiopancreatography, Endoscopic Retrograde*
Cross-Over Studies
Equipment Design
Female
Humans
Male
Sensitivity and Specificity
Single-Blind Method

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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