Open AccessAdvanced endoscopic imaging of indeterminate biliary strictures
Author(s) -
James H. Tabibian,
Kavel Visrodia,
Michael J. Levy,
Christopher J. Gostout
Publication year - 2015
Publication title -
world journal of gastrointestinal endoscopy
Language(s) - Uncategorized
Resource type - Journals
ISSN - 1948-5190
DOI - 10.4253/wjge.v7.i18.1268
Subject(s) - medicine , endomicroscopy , endoscopic ultrasound , radiology , endoscopic retrograde cholangiopancreatography , biliary tract , optical coherence tomography , endoscopy , surgery , pancreatitis , confocal , geometry , mathematics
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.