Study - Grasp or Brush for Biliary Sampling at ERCP?

[Guest guest]

Am

J Gastroenterol. 2007 Sep 27; [Epub ahead of

print]

Grasp or Brush for Biliary Sampling at Endoscopic

Retrograde Cholangiography? A

Blinded Randomized Controlled Trial.

Dumonceau JM, Macias Gomez C, Casco C, Genevay M, Marcolongo M, Bongiovanni M, Morel P, Majno P, Hadengue A.

Service of Gastroenterology and Hepatology, Geneva University Hospitals, Geneva, Switzerland.

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.

PMID: 17900324 [PubMed - as supplied by

publisher]

With love, Barb in Texas - Together in the Fight, Whatever it Takes!

Son Ken (33) UC 91 - PSC 99 - Tx 6/21 & 6/30/07 @ Baylor in Dallas