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CC BY 4.0 · Endoscopy
DOI: 10.1055/a-2728-8013
Innovations and brief communications

Intraductal cryobiopsy via percutaneous cholangioscopy for biliary strictures: a multicenter feasibility study

Authors

  • Jan Peveling-Oberhag‡

    1   Gastroenterology, Gastrointestinal Oncology, Hepatology and Infectious Diseases, Klinikum Stuttgart, Stuttgart, Germany (Ringgold ID: RIN14881)

  • Christian Gerges  ‡

    2   Clinic for Gastroenterology, Hepatology and Transplant Medicine, University Hospital Essen, Essen, Germany
    3   Internal Medicine II, Gastroenterology, Hepatology, Interventional Endoscopy, Infectiology, Health and Medical University, Campus Helios Clinic Krefeld, Krefeld, Germany

  • Jörg Albert

    1   Gastroenterology, Gastrointestinal Oncology, Hepatology and Infectious Diseases, Klinikum Stuttgart, Stuttgart, Germany (Ringgold ID: RIN14881)

  • Lukas Welsch

    4   Internal Medicine II, Clinic for Gastroenterology, Diabetology and Infectious Diseases, Klinikum Hanau GmbH, Hanau, Germany (Ringgold ID: RIN39790)

  • Philip Grunert

    2   Clinic for Gastroenterology, Hepatology and Transplant Medicine, University Hospital Essen, Essen, Germany

  • Gilbert Rahe

    2   Clinic for Gastroenterology, Hepatology and Transplant Medicine, University Hospital Essen, Essen, Germany

  • Alexander Dechene

    5   Internal Medicine 6, Gastroenterology, Klinikum Nürnberg, Nürnberg, Germany (Ringgold ID: RIN9211)

  • Axel Eickhoff

    6   Klinik für Gastroenterologie, Klinikum Hanau gGmbH, Hanau, Germany (Ringgold ID: RIN39790)

  • Matthias Dettmer

    7   Institute for Pathology, Klinikum Stuttgart, Stuttgart, Germany (Ringgold ID: RIN14881)
    8   Institute of Tissue Medicine and Pathology, University of Bern, Bern, Switzerland (Ringgold ID: RIN27210)

  • Walter Linzenbold

    9   Research Department, Erbe Elektromedizin GmbH, Tübingen, Germany (Ringgold ID: RIN27657)

  • Markus Enderle

    9   Research Department, Erbe Elektromedizin GmbH, Tübingen, Germany (Ringgold ID: RIN27657)

  • Thomas Rösch 

    10   Interdisciplinary Endoscopy, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany

  • Katharina Zimmermann-Fraedrich

    10   Interdisciplinary Endoscopy, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany

Supported by: Erbe Comp Tübingen Unrestricted grant for study personnel

Clinical Trial:

Registration number (trial ID): NCT06249841, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: prospective


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Abstract

Background

Tissue diagnosis of biliary strictures is challenging and often requires multiple methods. Cryobiopsy, which is well established in bronchoscopy with high tissue yield, is presented here for the first time as a proof-of-principle feasibility study performed via the percutaneous route for biliary strictures.

Methods

Patients undergoing percutaneous cholangioscopy for intraductal diagnosis of biliary strictures underwent six forceps biopsies and three cryobiopsies in a randomized order. The main objective was to assess feasibility, defined as the retrieval of at least one adequate sample per method per patient.

Results

Among 15 patients (53% women; mean age 60.2 years), all had at least one adequate sample obtained by each method. Cryobiopsy yielded significantly larger (8.54 vs. 1.87 mm2; P < 0.001) and more representative specimens (97.6% vs. 74.7%; P = 0.001). It also scored higher on overall histologic quality on a Likert scale of 0–6 (5 vs. 4; P < 0.001) and had more artifact-free areas (93.5% vs. 85.5%; P = 0.01). No bleeding or perforations occurred; only minor adverse events were reported and these resolved with standard treatment.

Conclusions

This feasibility study showed that intraductal cryobiopsy via percutaneous cholangioscopy yielded larger samples and may enable more detailed histologic assessment than forceps biopsies. Further studies will evaluate its accuracy, safety, and potential for use with peroral cholangioscopy during endoscopic retrograde cholangiopancreatography.

Supplementary Material



Publication History

Received: 25 March 2025

Accepted after revision: 27 September 2025

Accepted Manuscript online:
22 October 2025

Article published online:
19 December 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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