Diagnosing Biliary Malignancy

Gastrointest Endosc Clin N Am. 2015 Oct;25(4):677-90. doi: 10.1016/j.giec.2015.06.011.

Abstract

The most common malignant causes of biliary strictures are pancreatic cancer and cholangiocarcinoma. Differentiating between malignant and benign causes of biliary strictures has remained a clinical challenge. Endoscopic retrograde cholangiopancreatography (ERCP) remains the mainstay and first-line method of tissue diagnosis but has a poor diagnostic yield. This article reviews the causes of biliary strictures, the initial clinical evaluation of biliary obstruction, the diagnostic yield of ERCP-based sampling methods, the role of newer tools in the armamentarium for evaluating strictures, and ways to address the ongoing challenge of stricture evaluation in patients with primary sclerosing cholangitis.

Keywords: Cholangiocarcinoma (CCA); Endoscopic ultrasonography (EUS); Fluorescence in situ hybridization (FISH); Indeterminate biliary stricture; Intraductal ultrasonography (IDUS); Pancreatic cancer; Primary sclerosing cholangitis (PSC); Probe-based confocal endomicroscopy (pCLE).

Publication types

  • Review

MeSH terms

  • Biliary Tract / pathology
  • Biliary Tract Neoplasms / diagnosis*
  • Biliary Tract Neoplasms / etiology
  • Cholangiopancreatography, Endoscopic Retrograde / methods*
  • Cholangiopancreatography, Endoscopic Retrograde / statistics & numerical data
  • Cholangitis, Sclerosing / complications
  • Cholangitis, Sclerosing / surgery
  • Cholestasis / diagnosis*
  • Cholestasis / pathology
  • Constriction, Pathologic / diagnosis
  • Constriction, Pathologic / etiology
  • Humans
  • Sensitivity and Specificity