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Review
. 2022 May 16;14(5):291-301.
doi: 10.4253/wjge.v14.i5.291.

Endobiliary biopsy

Riccardo Inchingolo  1 , Fabrizio Acquafredda  2 , Alessandro Posa  3 , Thiago Franchi Nunes  4 , Stavros Spiliopoulos  5 , Francesco Panzera  6 , Carlos Alberto Praticò  7
Affiliations
Review

Endobiliary biopsy

Riccardo Inchingolo et al. World J Gastrointest Endosc. .

Abstract

The differential diagnosis between benign and malignant biliary strictures is challenging and requires a multidisciplinary approach with the use of serum biomarkers, imaging techniques, and several modalities of endoscopic or percutaneous tissue sampling. The diagnosis of biliary strictures consists of laboratory markers, and invasive and non-invasive imaging examinations such as computed tomography (CT), contrast-enhanced magnetic resonance cholangiopancreatography, and endoscopic ultrasonography (EUS). Nevertheless, invasive imaging modalities combined with tissue sampling are usually required to confirm the diagnosis of suspected malignant biliary strictures, while pathological diagnosis is mandatory to decide the optimal therapeutic strategy. Although EUS-guided fine-needle aspiration biopsy is currently the standard procedure for tissue sampling of solid pancreatic mass lesions, its diagnostic value in intraductal infiltrating type of cholangiocarcinoma remains limited. Moreover, the "endobiliary approach" using novel slim biopsy forceps, transpapillary and percutaneous cholangioscopy, and intraductal ultrasound-guided biopsy, is gaining ground on traditional endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography endobiliary forceps biopsy. This review focuses on the available endobiliary techniques currently used to perform biliary strictures biopsy, comparing the diagnostic performance of endoscopic and percutaneous approaches.

Keywords: Biliary strictures; Cholangioscopy; Endobiliary forceps biopsy; Endoscopic retrograde cholangiography; Intraductal ultrasound-guided biopsy; Percutaneous transhepatic.

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Conflict of interest statement

Conflict-of-interest statement: All the authors are aware of the content of the manuscript and have no conflict of interest.

Figures

Figure 1
Figure 1
Biliary stricture levels.
Figure 2
Figure 2
Endobiliary biopsy performed using the dedicated biopsy forceps (SpyByteTM), under PerOral Cholangioscopy.
Figure 3
Figure 3
Endobiliary biopsy performed using the dedicated biopsy forceps (SpyByteTM), under Perctaneous Cholangioscopy. A 63 year female, with history of Whipple’s procedure 20 years before. A: Cholangiography revealed multiple endoluminal defects (red arrow); B: Endobiliary biopsy using SpyByte, under fluoroscopy and cholangioscopy; C: Histological examination revealed intestinal metaplasia of the biliary mucosa.
See this image and copyright information in PMC

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