30 Endoscopy-Based Brushing Passes Better Detect Malignant Biliary Strictures

NEW YORK (Reuters Health) – Endoscopic biliary brushing 30 times in one specimen significantly improves diagnostic sensitivity compared with brushing just 10 times, without increasing complications, according to a study from China.

“Endoscopic retrograde cholangiopancreatography (ERCP)-based sampling plays an important role in the diagnosis of malignant biliary strictures (MBSs) and guides further therapies. ERCP-based brush cytology remains the first-line approach for sample acquisition because of its simplicity, safety, low cost, and high specificity,” write Dr. XiaoBo Cai with Department of Gastroenterology, Shanghai General Hospital and Shanghai Jiao Tong University School of Medicine, and colleagues.

However, its sensitivity is relatively low and there is no consensus on endoscopy-based biliary brushing, although brushing 10 times in one specimen is routine, they point out.

The research team compared the sensitivity of 10, 20, or 30 brushing times in a single specimen in 443 patients with MBSs; with 147, 148, and 148 patients in the 10-, 20-, and 30-times groups, respectively. The three groups were similar in their baseline characteristics.

The sensitivity of brush cytology was highest in the 30-times brushing group (57%), followed by the 20-times group (47%), and the 10-times brushing group (38%).

The 30-times brushing group showed significantly higher sensitivity than the 10-times group (P=0.001), the authors report in the American Journal of Gastroenterology.

There were no significant differences in procedure-related complications among the three groups.

“Our results showed that ERCP-based brushing of 30 times for one specimen was safe, easily performed, and may increase the detection rate for MBSs,” the authors write.

Based on their findings, they say 30-times “seems to be preferred” for endoscopic sampling and diagnosis of MBS. They note that brushing 30 times may only take an additional 20 to 30 seconds.

They acknowledge that further large-scale studies are needed to confirm their findings.

This study was supported by the clinical research innovation plan of Shanghai General Hospital, China. The authors have no relevant disclosures.

SOURCE: https://bit.ly/3sInTPQ American Journal of Gastroenterology, online February 2, 2022.

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