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High sensitivity of ROSE-supported ERCP-guided brushing for biliary strictures
Livia Archibugi1, Alberto Mariani1, Biagio Ciambriello2
1Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, Vita-Salute San Raffaele University, Milan, Italy, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Rapid on-site evaluation (ROSE) significantly improves the diagnostic yield of endoscopic retrograde cholangiopancreatography (ERCP)-guided brushing for biliary strictures. This technique enhances sensitivity and specificity, offering a more accurate diagnosis compared to brushing alone.
Area of Science:
- Gastroenterology
- Oncology
- Diagnostic Cytopathology
Background:
- Endoscopic retrograde cholangiopancreatography (ERCP) is crucial for managing biliary strictures.
- ERCP-guided brushing offers a cost-effective method for cytological diagnosis but has limited sensitivity (around 45%).
- Rapid on-site evaluation (ROSE) is established for improving specimen adequacy in endoscopic ultrasound but its role in ERCP-guided brushing is unevaluated.
Purpose of the Study:
- To assess the diagnostic yield of ERCP-guided biliary stricture brushing when supported by ROSE.
- To determine if ROSE enhances the accuracy of cytological diagnosis for biliary strictures.
Main Methods:
- A retrospective single-center study included 206 patients undergoing ERCP-guided brush cytology with ROSE for biliary strictures.
- Data collected included clinical, radiological, and ERCP features.
- Final diagnosis was confirmed post-surgery, intraductal biopsy, or adequate follow-up.
Main Results:
- ROSE ensured adequate samples in 99% of cases after a mean of 2.6 passages.
- The diagnostic yield demonstrated an accuracy of 83%, sensitivity of 74.6%, and specificity of 98%.
- Cholangiocarcinoma was more frequent in true-positive cases (68% vs. 46.8%, P=0.04).
Conclusions:
- This is the first study to demonstrate the utility of ROSE in supporting ERCP-guided brushing for biliary strictures.
- ROSE significantly increases the sensitivity of ERCP-guided brushing, surpassing previous reports for brushing alone.
- The diagnostic performance is comparable to more invasive and costly techniques.
