Grasp or brush for biliary sampling at endoscopic retrograde cholangiography? A blinded randomized controlled trial.
Détails
ID Serval
serval:BIB_E2152E7CC8A0
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Grasp or brush for biliary sampling at endoscopic retrograde cholangiography? A blinded randomized controlled trial.
Périodique
American Journal of Gastroenterology
ISSN
0002-9270 (Print)
ISSN-L
0002-9270
Statut éditorial
Publié
Date de publication
2008
Volume
103
Numéro
2
Pages
333-340
Langue
anglais
Notes
Publication types: Comparative Study ; Journal Article ; Multicenter Study ; Randomized Controlled Trial Publication Status: ppublish
Résumé
OBJECTIVES: Brushing, the standard sampling method at endoscopic retrograde cholangiography (ERC), lacks sensitivity for cancer detection. We assessed a novel sampling method using a grasping basket.
METHODS: Fifty-six patients with a suspected malignant biliary stricture were randomized to biliary sampling at ERC using a basket (basket group, N = 30) or a brush (brush group, N = 26), followed by the alternate device. When deemed necessary, strictures were dilated (using 6-mm balloons exclusively). The primary end point was sensitivity for cancer detection at cytopathological examination of the first sample collected in each patient; the cytopathologist was blinded to clinical details and sampling method. All analyses followed an intention-to-treat principle.
RESULTS: All 56 patients had successful sampling with both techniques; 50 (89%) had a final diagnosis of malignant stricture. Sensitivity for cancer detection with the first sample collected in each patient was significantly higher in the basket compared to brush group (20/25 [80%]vs 12/25 [48%], respectively, P= 0.018, OR 4.33, 95% CI 1.24-15.21). Seventeen (34%) of the 50 sample pairs collected from malignant cases showed discordant cytopathological results: 15 patients had a positive basket and a negative brush result while two had the inverse association (P= 0.002, OR 7.5, 95% CI 1.65-47.44). Basketting more frequently yielded positive samples from malignant strictures in case of presampling balloon dilation (27/32 [84%]vs 10/18 [56%], respectively, P= 0.043, OR 4.32, 95% CI 1.14-16.37). Specificity was 100% (both methods).
CONCLUSION: Biliary sampling at ERC using a dedicated basket provided a significantly higher sensitivity for cancer detection than brushing; presampling stricture dilation significantly increased sensitivity.
METHODS: Fifty-six patients with a suspected malignant biliary stricture were randomized to biliary sampling at ERC using a basket (basket group, N = 30) or a brush (brush group, N = 26), followed by the alternate device. When deemed necessary, strictures were dilated (using 6-mm balloons exclusively). The primary end point was sensitivity for cancer detection at cytopathological examination of the first sample collected in each patient; the cytopathologist was blinded to clinical details and sampling method. All analyses followed an intention-to-treat principle.
RESULTS: All 56 patients had successful sampling with both techniques; 50 (89%) had a final diagnosis of malignant stricture. Sensitivity for cancer detection with the first sample collected in each patient was significantly higher in the basket compared to brush group (20/25 [80%]vs 12/25 [48%], respectively, P= 0.018, OR 4.33, 95% CI 1.24-15.21). Seventeen (34%) of the 50 sample pairs collected from malignant cases showed discordant cytopathological results: 15 patients had a positive basket and a negative brush result while two had the inverse association (P= 0.002, OR 7.5, 95% CI 1.65-47.44). Basketting more frequently yielded positive samples from malignant strictures in case of presampling balloon dilation (27/32 [84%]vs 10/18 [56%], respectively, P= 0.043, OR 4.32, 95% CI 1.14-16.37). Specificity was 100% (both methods).
CONCLUSION: Biliary sampling at ERC using a dedicated basket provided a significantly higher sensitivity for cancer detection than brushing; presampling stricture dilation significantly increased sensitivity.
Mots-clé
Aged, Bile Ducts/pathology, Biopsy/instrumentation, Biopsy/methods, Cholangiopancreatography, Endoscopic Retrograde, Cross-Over Studies, Equipment Design, Female, Humans, Male, Sensitivity and Specificity, Single-Blind Method
Pubmed
Web of science
Création de la notice
05/02/2015 12:28
Dernière modification de la notice
20/08/2019 17:06