FUNDAMENTAL TECHNIQUE AND PITFALLS OF ENDOSCOPIC TRANSPAPILLARY BIOPSY AND CYTOLOGY

Abstract

Forceps biopsy and cytology during endoscopic retrograde cholangiopancreatography (ERCP) procedures are frequently performed in patients with pancreatobiliary diseases. However, the accuracy of these procedures has not been satisfactory. As for biliary diseases, a combination of bile duct biopsy and cytological examination including brush cytology could improve the accuracy of diagnosis. In addition, a recent study reported that a new endoscopic scraper demonstrated a large sample yield and high cancer detectability in malignant biliary strictures. As for pancreatic diseases, the accuracy of pancreatic duct biopsy for intraductal pancreatic tumor has not been satisfactory. Serial pancreatic-juice aspiration cytologic examination (SPACE) using pancreatic juice should be performed along with procedures such as pancreatic duct brushing and endoscopic nasopancreatic drainage (ENPD). A combination of pancreatic duct biopsy and cytology could improve the accuracy of detection and diagnosis of pancreatic diseases.