Intraductal cryobiopsy via percutaneous cholangioscopy for biliary strictures: a multicenter feasibility study

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Surgical Pathology

Background:

• Tissue diagnosis of biliary strictures presents significant challenges, often necessitating a combination of diagnostic modalities.
• Percutaneous cryobiopsy, a technique known for high tissue yield in bronchoscopy, is explored for the first time in biliary strictures.

Purpose of the Study:

• To evaluate the feasibility of intraductal cryobiopsy via percutaneous cholangioscopy for diagnosing biliary strictures.
• To compare the quality and representativeness of tissue samples obtained via cryobiopsy versus traditional forceps biopsies.

Main Methods:

• A feasibility study involving 15 patients undergoing percutaneous cholangioscopy for biliary stricture diagnosis.
• Patients received randomized forceps biopsies and cryobiopsies, with feasibility defined as obtaining at least one adequate sample per method.
• Specimen size, representativeness, histologic quality, and artifacts were analyzed.

Main Results:

• Both cryobiopsy and forceps biopsy achieved feasibility in all patients.
• Cryobiopsy yielded significantly larger (8.54 mm² vs. 1.87 mm²) and more representative (97.6% vs. 74.7%) specimens.
• Cryobiopsy demonstrated superior histologic quality (Likert 5 vs. 4) and fewer artifacts (95% vs. 85.5%) with no major adverse events.

Conclusions:

• Intraductal cryobiopsy via percutaneous cholangioscopy is feasible and provides larger, more representative tissue samples than forceps biopsies.
• This technique may enhance histologic assessment for biliary strictures.
• Further research is warranted to assess accuracy, safety, and potential use with peroral cholangioscopy during ERCP.