Diagnostic value of endoscopic transampullary biopsy for malignant bile duct stricture

Bile duct stricture, either benign or malignant, usually presented with jaundice, is a common surgical condition. Clinically the diagnosis is made empirically on the basis of clinical data and a telltale cholangiogram without histologic confirmation. Benign stricture, therefore, might be misinterpreted as malignancy. To obtain tissue confirmation, endoscopic transampullary biopsies were performed in 32 patients with clinically suspected malignant biliary stricture, between August 1997 and July 1998. Of these 32 patients, 16 patients each had biopsy-positive and biopsy-negative for malignancy. In the 16 biopsy-positive patients, 11 underwent exploratory laparotomy, and the other 5 did not. Of the 11 who were explored, 8 had histology confirmed malignancy, surgical biopsy was not feasible in the 3 remaining patients. The 5 patients who were not explored, all died within 5 months after the diagnosis was made. In the 16 biopsy-negative patients, 9 underwent exploratory laparotomy, of which 4 had malignancy confirmed histologically, 2 had no malignancy by histology but subsequently had clinical evidence which suggested malignancy, in the 3 remaining patients surgical biopsy was not feasible, however, their clinical courses suggested a benign condition. Of the 7 patients whose transampullary biopsies were negative, and who were not explored, 5 had a clinical course and evidence suggesting malignancy, of these 5 patients 4 died 1, 2, 3 and 10 months after the diagnosis, and one was lost to follow-up. The 2 remaining patients who had no clinical evidence of malignancy remained alive even 2 years after the follow-up. Of the patients who underwent exploratory laparotomy and surgical biopsy, the sensitivity, specificity, positive predictive value and negative predictive value for transampullary biopsy were 66.7 per cent, 100 per cent, 100 per cent and 31.3 per cent respectively. There were no major complications related to transampullary biopsy per se. The results suggested that transampullary biopsy is an effective and safe procedure for diagnosing malignant bile duct stricture.