Endoscopic ultrasound and fine-needle aspiration of unexplained bile duct strictures

Am J Gastroenterol. 2004 Jun;99(6):1069-73. doi: 10.1111/j.1572-0241.2004.30223.x.


Objectives: The aim of this study was to assess the utility of endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) in patients with unexplained common bile duct strictures after endoscopic retrograde cholangiopancreatography (ERCP) and intraductal tissue sampling.

Methods: Records were reviewed for all subjects undergoing EUS for evaluation of unexplained bile duct strictures at our institution. 40 subjects had either a final histologic diagnosis (24) or no evidence of malignancy after at least 1 yr of follow-up (16).

Results: The finding of a pancreatic head mass and/or an irregular bile duct wall had sensitivity for malignancy of 88%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 84%. Bile duct wall thickness >/=3 mm had a sensitivity for malignancy of 79%, specificity of 79%, positive predictive value of 73%, and negative predictive value of 80%. Sensitivity of EUS FNA for malignancy was 47% with specificity 100%, positive predictive value 100%, and negative predictive value 50%.

Conclusions: Sonographic features may be more sensitive than EUS FNA for diagnosis of unexplained bile duct strictures and include presence of a pancreatic mass, an irregular bile duct wall, or bile duct wall thickness > 3 mm. EUS FNA cytology is specific but insensitive for diagnosis. EUS improves the diagnosis of otherwise unexplained bile duct strictures.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biliary Tract Neoplasms / diagnostic imaging*
  • Biliary Tract Neoplasms / pathology*
  • Biopsy, Needle / methods*
  • Cholestasis / diagnostic imaging*
  • Cholestasis / pathology*
  • Endosonography / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Registries
  • Retrospective Studies
  • Risk Assessment
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Time Factors