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G A Lehman - One of the best experts on this subject based on the ideXlab platform.
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Tissue Sampling at ERCP in suspected malignant biliary strictures (Part 2).
Gastrointestinal endoscopy, 2002Co-Authors: Mario De Bellis, E L Fogel, S Sherman, Harvey M. Cramer, John Chappo, Lee Mchenry, James L. Watkins, G A LehmanAbstract:Part I of this review in the previous issue of Gastrointestinal Endoscopy outlined the key points of Tissue Sampling at ERCP and considered intraductal bile aspiration cytology, cytologic/histologic analysis of retrieved plastic biliary stents and fine needle aspiration cytology. Specimen adequacy, slide preparation, and accuracy of slide interpretation, which is often influenced by the interpretation “philosophy” of individual cytopathologists, are fundamental to the effort to optimize cancer detection by using Tissue Sampling techniques at ERCP. Intraductal bile aspiration is simple and inexpensive but adds little to the other methods, which have higher rates of cancer detection. Therefore, bile aspiration is recommended only when other Sampling techniques cannot be used. Cytologic evaluation of material from retrieved plastic biliary stents is relatively insensitive (32%) and impractical as a firstline approach to the diagnosis of malignant biliary obstruction because diagnosis is delayed until the stent is removed. However, it can be considered in patients undergoing stent exchange when other methods of Tissue Sampling fail to confirm the suspected diagnosis of malignancy. Endoscopic fineneedle aspiration (FNA) cytology has a lower rate of cancer detection (33%) than initially reported and is technically difficult. It is usually used to supplement other simpler methods. Part II of this review considers the remaining Tissue Sampling methods for use at ERCP: brush cytology, endobiliary forceps biopsy, and the multimodal Tissue Sampling. Methods for improving diagnostic yield are discussed. BRUSH CYTOLOGY
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triple Tissue Sampling at ercp in malignant biliary obstruction
Gastrointestinal Endoscopy, 2000Co-Authors: J Jailwala, E L Fogel, S Sherman, K Gottlieb, J Flueckiger, L G Bucksot, G A LehmanAbstract:Abstract Background: Procurement of cytologic samples by brushing is common practice at endoscopic retrograde cholangiopancreatography (ERCP) but has low sensitivity for cancer detection. Limited data are available on other techniques, including endoluminal fine-needle aspiration and forceps biopsy. This series reviews the yield of these three stricture Sampling methods. Methods: In this prospective study, patients with biliary obstruction with a clinical suspicion of malignancy underwent triple-Tissue Sampling at one ERCP session. Final cancer diagnosis was based on all Sampling methods plus surgery, autopsy, and clinical follow-up. Tissue specimens were reported as normal, atypia, or malignant. Results: A total of 133 patients were evaluated: 104 had cancer and 29 had benign strictures. Tissue Sampling sensitivity varied according to the type of cancer; the highest yield was seen in ampullary cancers (62% to 85%). The cumulative sensitivity of triple-Tissue Sampling in the cancer patients was as follows: sensitivity was 52% if atypia was considered benign and 77% if it was considered malignant. The addition of a second or third technique increased sensitivity rates in most instances. No serious complications occurred from the Tissue Sampling methods. Conclusions: Tissue Sampling sensitivity varied according to the type of cancer. Combining a second or third method increased sensitivity; general use of at least two Sampling methods is therefore recommended. (Gastrointest Endosc 2000;51:383-90.)
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Triple-Tissue Sampling at ERCP in malignant biliary obstruction.
Gastrointestinal endoscopy, 2000Co-Authors: J Jailwala, E L Fogel, S Sherman, K Gottlieb, J Flueckiger, L G Bucksot, G A LehmanAbstract:Procurement of cytologic samples by brushing is common practice at endoscopic retrograde cholangiopancreatography (ERCP) but has low sensitivity for cancer detection. Limited data are available on other techniques, including endoluminal fine-needle aspiration and forceps biopsy. This series reviews the yield of these three stricture Sampling methods. In this prospective study, patients with biliary obstruction with a clinical suspicion of malignancy underwent triple-Tissue Sampling at one ERCP session. Final cancer diagnosis was based on all Sampling methods plus surgery, autopsy, and clinical follow-up. Tissue specimens were reported as normal, atypia, or malignant. A total of 133 patients were evaluated: 104 had cancer and 29 had benign strictures. Tissue Sampling sensitivity varied according to the type of cancer; the highest yield was seen in ampullary cancers (62% to 85%). The cumulative sensitivity of triple-Tissue Sampling in the cancer patients was as follows: sensitivity was 52% if atypia was considered benign and 77% if it was considered malignant. The addition of a second or third technique increased sensitivity rates in most instances. No serious complications occurred from the Tissue Sampling methods. Tissue Sampling sensitivity varied according to the type of cancer. Combining a second or third method increased sensitivity; general use of at least two Sampling methods is therefore recommended.
Fabio Tuzzolino - One of the best experts on this subject based on the ideXlab platform.
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intraductal aspiration a promising new Tissue Sampling technique for the diagnosis of suspected malignant biliary strictures
Gastrointestinal Endoscopy, 2012Co-Authors: Gabriele Curcio, Mario Traina, F Mocciaro, Rosa Liotta, Raffaella Gentile, Ilaria Tarantino, Luca Barresi, Antonino Granata, Fabio TuzzolinoAbstract:Background Brushing is the most commonly used technique for biliary Sampling at ERCP, despite its limited sensitivity. Objective To evaluate intraductal aspiration (IDA) as a new combined endoscopic technique for cytodiagnosis, its cellular adequacy, diagnostic accuracy for cancer detection, feasibility, and safety. Design Prospective, observational study. Setting Single tertiary referral center. Main Outcome Measurements IDA cellular adequacy, diagnostic accuracy for cancer detection, feasibility, and safety. Patients and Methods From April 2009 to September 2010, 42 consecutive patients with suspected malignant biliary stricture underwent ERCP, with Tissue Sampling obtained with IDA. IDA included performance of standard brushing in all patients. After standard brushing, to perform IDA, we removed the brush from its catheter and used the tip of the catheter as a scraping device. The tip was scraped back and forth across the stricture at least 10 times. The catheter and a suction line were connected to a specimen trap to obtain intraductal aspiration of fluids and Samplings. Results Our cytopathologists found adequate cellular yield in 39 of the 42 IDA samples (92.8%) versus 15 of the 42 brushing samples (35.7%) ( P Limitations Observational study, small number of patients. Conclusions IDA significantly improves brushing cellular adequacy and has high sensitivity for cancer detection. It was also safe, simple, rapid, and applicable during routine diagnostic ERCP, with no additional costs.
Douglas O Faigel - One of the best experts on this subject based on the ideXlab platform.
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yield of Tissue Sampling for subepithelial lesions evaluated by eus a comparison between forceps biopsies and endoscopic submucosal resection
Gastrointestinal Endoscopy, 2006Co-Authors: Michael J Cantor, Raquel E Davila, Douglas O FaigelAbstract:Background In most circumstances, subepithelial tumors lack distinct endoscopic and ultrasonographic features. Consequently, definitive diagnosis usually requires Tissue acquisition and pathologic confirmation. Establishing a Tissue diagnosis is difficult because the yield of forceps biopsies is low. However, prospective data evaluating Tissue Sampling techniques for subepithelial lesions are currently lacking. Objective Our purpose was to prospectively determine the diagnostic yield of endoscopic submucosal-mucosal resection (ESMR) compared with forceps biopsy for lesions limited to the submucosa (third endosonographic layer) of the GI tract. Design A prospective head-to-head comparison was performed. Setting The study was performed in a tertiary care hospital. Patients Study patients were 23 adults with subepithelial lesions limited to the submucosa. Intervention All submucosal lesions underwent forceps biopsy followed by endoscopic submucosal resection. Biopsy speciments were obtained with large-capacity "jumbo" forceps. A total of 4 double passes (8 biopsy specimens) were collected from each lesion with use of the bite-on-bite technique. Endoscopic resection was then performed with an electrosurgical snare or cap-fitted endoscopic mucosal resection device. Main Outcome Measurement The main outcome measurement was the diagnostic yield of biopsy forceps compared with endoscopic submucosal resection. Results Twenty-three patients with lesions limited to the submucosa were identified by endoscopic ultrasonography. All lesions underwent forceps biopsy followed by ESMR. The diagnostic yield of the jumbo forceps biopsy was 4 of 23 (17%), whereas the diagnostic yield of ESMR was 20 of 23 (87%) ( P = .0001, McNemar test). Conclusion In the evaluation of subepithelial lesions limited to the submucosa, ESMR has a significantly higher diagnostic yield than jumbo forceps biopsy with use of the bite-on-bite technique.
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yield of Tissue Sampling for submucosal lesions evaluated by eus
Gastrointestinal Endoscopy, 2003Co-Authors: Gordon C Hunt, Pamela P Smith, Douglas O FaigelAbstract:Abstract Background: Evaluation of submucosal nodules or large gastric folds is a common indication for EUS. Establishing a Tissue diagnosis is challenging because the yield of forceps biopsies is low. The aim of this study was to determine the diagnostic yield of EUS-guided endoscopic submucosal-mucosal resection and forceps biopsy for submucosal nodules and large gastric folds. Methods: Patients who underwent EUS from March 1997 through January 2002 for evaluation of submucosal nodules or large gastric folds were identified, and the procedure and pathology reports reviewed. Patients were included who underwent endoscopic submucosal-mucosal resection (n = 45) or large-capacity ("jumbo") biopsy (n = 36) of submucosal lesions (arising from third endosonographic layer) or large gastric folds. Endoscopic submucosal-mucosal resection was performed with an electrosurgical snare or with a cap-fitted endoscopic mucosal resection device. Results: Sixty-six patients (62% men; mean age, 61 years; range 27-80 years) underwent 69 EUS procedures to obtain Tissue samples of subepithelial lesions. Diagnostic yields were as follows: endoscopic submucosal-mucosal resection 40/45 (89%; 95% CI [80%, 98%]), jumbo biopsy 15/36 (42%; 95% CI [26%, 58%]) ( p Conclusions: For submucosal lesions and large gastric folds, endoscopic submucosal-mucosal resection has a better diagnostic yield than the jumbo biopsy, but may have a higher complication rate. (Gastrointest Endosc 2003;57:68-72.)
S Sherman - One of the best experts on this subject based on the ideXlab platform.
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Tissue Sampling at ERCP in suspected malignant biliary strictures (Part 2).
Gastrointestinal endoscopy, 2002Co-Authors: Mario De Bellis, E L Fogel, S Sherman, Harvey M. Cramer, John Chappo, Lee Mchenry, James L. Watkins, G A LehmanAbstract:Part I of this review in the previous issue of Gastrointestinal Endoscopy outlined the key points of Tissue Sampling at ERCP and considered intraductal bile aspiration cytology, cytologic/histologic analysis of retrieved plastic biliary stents and fine needle aspiration cytology. Specimen adequacy, slide preparation, and accuracy of slide interpretation, which is often influenced by the interpretation “philosophy” of individual cytopathologists, are fundamental to the effort to optimize cancer detection by using Tissue Sampling techniques at ERCP. Intraductal bile aspiration is simple and inexpensive but adds little to the other methods, which have higher rates of cancer detection. Therefore, bile aspiration is recommended only when other Sampling techniques cannot be used. Cytologic evaluation of material from retrieved plastic biliary stents is relatively insensitive (32%) and impractical as a firstline approach to the diagnosis of malignant biliary obstruction because diagnosis is delayed until the stent is removed. However, it can be considered in patients undergoing stent exchange when other methods of Tissue Sampling fail to confirm the suspected diagnosis of malignancy. Endoscopic fineneedle aspiration (FNA) cytology has a lower rate of cancer detection (33%) than initially reported and is technically difficult. It is usually used to supplement other simpler methods. Part II of this review considers the remaining Tissue Sampling methods for use at ERCP: brush cytology, endobiliary forceps biopsy, and the multimodal Tissue Sampling. Methods for improving diagnostic yield are discussed. BRUSH CYTOLOGY
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triple Tissue Sampling at ercp in malignant biliary obstruction
Gastrointestinal Endoscopy, 2000Co-Authors: J Jailwala, E L Fogel, S Sherman, K Gottlieb, J Flueckiger, L G Bucksot, G A LehmanAbstract:Abstract Background: Procurement of cytologic samples by brushing is common practice at endoscopic retrograde cholangiopancreatography (ERCP) but has low sensitivity for cancer detection. Limited data are available on other techniques, including endoluminal fine-needle aspiration and forceps biopsy. This series reviews the yield of these three stricture Sampling methods. Methods: In this prospective study, patients with biliary obstruction with a clinical suspicion of malignancy underwent triple-Tissue Sampling at one ERCP session. Final cancer diagnosis was based on all Sampling methods plus surgery, autopsy, and clinical follow-up. Tissue specimens were reported as normal, atypia, or malignant. Results: A total of 133 patients were evaluated: 104 had cancer and 29 had benign strictures. Tissue Sampling sensitivity varied according to the type of cancer; the highest yield was seen in ampullary cancers (62% to 85%). The cumulative sensitivity of triple-Tissue Sampling in the cancer patients was as follows: sensitivity was 52% if atypia was considered benign and 77% if it was considered malignant. The addition of a second or third technique increased sensitivity rates in most instances. No serious complications occurred from the Tissue Sampling methods. Conclusions: Tissue Sampling sensitivity varied according to the type of cancer. Combining a second or third method increased sensitivity; general use of at least two Sampling methods is therefore recommended. (Gastrointest Endosc 2000;51:383-90.)
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Triple-Tissue Sampling at ERCP in malignant biliary obstruction.
Gastrointestinal endoscopy, 2000Co-Authors: J Jailwala, E L Fogel, S Sherman, K Gottlieb, J Flueckiger, L G Bucksot, G A LehmanAbstract:Procurement of cytologic samples by brushing is common practice at endoscopic retrograde cholangiopancreatography (ERCP) but has low sensitivity for cancer detection. Limited data are available on other techniques, including endoluminal fine-needle aspiration and forceps biopsy. This series reviews the yield of these three stricture Sampling methods. In this prospective study, patients with biliary obstruction with a clinical suspicion of malignancy underwent triple-Tissue Sampling at one ERCP session. Final cancer diagnosis was based on all Sampling methods plus surgery, autopsy, and clinical follow-up. Tissue specimens were reported as normal, atypia, or malignant. A total of 133 patients were evaluated: 104 had cancer and 29 had benign strictures. Tissue Sampling sensitivity varied according to the type of cancer; the highest yield was seen in ampullary cancers (62% to 85%). The cumulative sensitivity of triple-Tissue Sampling in the cancer patients was as follows: sensitivity was 52% if atypia was considered benign and 77% if it was considered malignant. The addition of a second or third technique increased sensitivity rates in most instances. No serious complications occurred from the Tissue Sampling methods. Tissue Sampling sensitivity varied according to the type of cancer. Combining a second or third method increased sensitivity; general use of at least two Sampling methods is therefore recommended.
E L Fogel - One of the best experts on this subject based on the ideXlab platform.
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Tissue Sampling at ERCP in suspected malignant biliary strictures (Part 2).
Gastrointestinal endoscopy, 2002Co-Authors: Mario De Bellis, E L Fogel, S Sherman, Harvey M. Cramer, John Chappo, Lee Mchenry, James L. Watkins, G A LehmanAbstract:Part I of this review in the previous issue of Gastrointestinal Endoscopy outlined the key points of Tissue Sampling at ERCP and considered intraductal bile aspiration cytology, cytologic/histologic analysis of retrieved plastic biliary stents and fine needle aspiration cytology. Specimen adequacy, slide preparation, and accuracy of slide interpretation, which is often influenced by the interpretation “philosophy” of individual cytopathologists, are fundamental to the effort to optimize cancer detection by using Tissue Sampling techniques at ERCP. Intraductal bile aspiration is simple and inexpensive but adds little to the other methods, which have higher rates of cancer detection. Therefore, bile aspiration is recommended only when other Sampling techniques cannot be used. Cytologic evaluation of material from retrieved plastic biliary stents is relatively insensitive (32%) and impractical as a firstline approach to the diagnosis of malignant biliary obstruction because diagnosis is delayed until the stent is removed. However, it can be considered in patients undergoing stent exchange when other methods of Tissue Sampling fail to confirm the suspected diagnosis of malignancy. Endoscopic fineneedle aspiration (FNA) cytology has a lower rate of cancer detection (33%) than initially reported and is technically difficult. It is usually used to supplement other simpler methods. Part II of this review considers the remaining Tissue Sampling methods for use at ERCP: brush cytology, endobiliary forceps biopsy, and the multimodal Tissue Sampling. Methods for improving diagnostic yield are discussed. BRUSH CYTOLOGY
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triple Tissue Sampling at ercp in malignant biliary obstruction
Gastrointestinal Endoscopy, 2000Co-Authors: J Jailwala, E L Fogel, S Sherman, K Gottlieb, J Flueckiger, L G Bucksot, G A LehmanAbstract:Abstract Background: Procurement of cytologic samples by brushing is common practice at endoscopic retrograde cholangiopancreatography (ERCP) but has low sensitivity for cancer detection. Limited data are available on other techniques, including endoluminal fine-needle aspiration and forceps biopsy. This series reviews the yield of these three stricture Sampling methods. Methods: In this prospective study, patients with biliary obstruction with a clinical suspicion of malignancy underwent triple-Tissue Sampling at one ERCP session. Final cancer diagnosis was based on all Sampling methods plus surgery, autopsy, and clinical follow-up. Tissue specimens were reported as normal, atypia, or malignant. Results: A total of 133 patients were evaluated: 104 had cancer and 29 had benign strictures. Tissue Sampling sensitivity varied according to the type of cancer; the highest yield was seen in ampullary cancers (62% to 85%). The cumulative sensitivity of triple-Tissue Sampling in the cancer patients was as follows: sensitivity was 52% if atypia was considered benign and 77% if it was considered malignant. The addition of a second or third technique increased sensitivity rates in most instances. No serious complications occurred from the Tissue Sampling methods. Conclusions: Tissue Sampling sensitivity varied according to the type of cancer. Combining a second or third method increased sensitivity; general use of at least two Sampling methods is therefore recommended. (Gastrointest Endosc 2000;51:383-90.)
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Triple-Tissue Sampling at ERCP in malignant biliary obstruction.
Gastrointestinal endoscopy, 2000Co-Authors: J Jailwala, E L Fogel, S Sherman, K Gottlieb, J Flueckiger, L G Bucksot, G A LehmanAbstract:Procurement of cytologic samples by brushing is common practice at endoscopic retrograde cholangiopancreatography (ERCP) but has low sensitivity for cancer detection. Limited data are available on other techniques, including endoluminal fine-needle aspiration and forceps biopsy. This series reviews the yield of these three stricture Sampling methods. In this prospective study, patients with biliary obstruction with a clinical suspicion of malignancy underwent triple-Tissue Sampling at one ERCP session. Final cancer diagnosis was based on all Sampling methods plus surgery, autopsy, and clinical follow-up. Tissue specimens were reported as normal, atypia, or malignant. A total of 133 patients were evaluated: 104 had cancer and 29 had benign strictures. Tissue Sampling sensitivity varied according to the type of cancer; the highest yield was seen in ampullary cancers (62% to 85%). The cumulative sensitivity of triple-Tissue Sampling in the cancer patients was as follows: sensitivity was 52% if atypia was considered benign and 77% if it was considered malignant. The addition of a second or third technique increased sensitivity rates in most instances. No serious complications occurred from the Tissue Sampling methods. Tissue Sampling sensitivity varied according to the type of cancer. Combining a second or third method increased sensitivity; general use of at least two Sampling methods is therefore recommended.
