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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(09): E1233-E1237
DOI: 10.1055/a-1897-4686
Original article

Histological assessment of new cholangioscopy-guided forceps in ERCP biliary stricture sampling: a blinded comparative study

Eric J. Vargas
1   Department of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, United States
,
Yaohong Wang
2   Vanderbilt University School of Medicine, Pathology, Microbiology and Immunology, Nashville, Tennessee, United States
,
Zongming Eric Chen
3   Department of Pathology, Mayo Clinic Rochester, Rochester, Minnesota, United States
,
Rami Abusaleh
1   Department of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, United States
,
Andrew C. Storm
1   Department of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, United States
,
John A. Martin
1   Department of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, United States
,
Ryan J. Law
1   Department of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, United States
,
Barham K. Abu Dayyeh
1   Department of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, United States
,
Michael J. Levy
1   Department of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, United States
,
Bret Petersen
1   Department of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, United States
,
Vinay Chandrasekhara
1   Department of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, United States
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Abstract

Background and study aims Obtaining quality tissue during ERCP biliary stricture sampling is of paramount importance for a timely diagnosis. While single-operator cholangioscopy (SOC)-guided biopsies have been suggested to be the superior biliary tissue acquisition modality given direct tissue visualization, less is known about the specimen histological quality. We aimed to analyze the specimen quality of SOC biopsies and compare the new generation forceps with prior “legacy” forceps.

Patients and methods Patients who underwent SOC from January 2017-August 2021 for biliary sampling were reviewed. In February 2020, the SOC-guided biopsy forceps were changed from legacy SpyBite to the SpyBite Max forceps (max). Specimens were assessed by blinded pathologists for crush artifact (none, mild, or severe) and gross size (greatest dimension in mm). Crush artifact and gross size were compared between the two groups. The diagnostic performance characteristics for cholangiocarcinoma (CCA), were assessed in an exploratory fashion.

Results Eighty-one patients (max = 27, legacy = 54) with similar baseline characteristics were included in this study. On blinded pathological assessment, 58 % had crush artifact, without significant differences between the two groups (Max 63 % vs. Legacy 56 %; P = 0.64). A similar mean specimen size was found (max 3 mm vs. legacy 3.2 mm; P = 0.24). The overall prevalence of CCA was 40 %. The sensitivity, specificity, positive predictive value, and negative predictive value of the entire cohort using a combination of cytology, fluorescence in situ hybridization, and SOC-guided biopsies were 78.1 %, 91.8 %, 86.2 %, and 86.5 %, respectively. No difference between legacy or max groups was found.

Conclusions A high rate of crush artifact was found in SOC-guided biopsy specimens. Further investigation regarding proper biopsy technique and handling is necessary to increase the diagnostic yield with SOC-guided biopsies.



Publication History

Received: 03 December 2021

Accepted after revision: 24 June 2022

Article published online:
14 September 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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