| Theme |
Malignant Biliary Stricture -- Recent Advancements on Diagnosis & Treatment |
| Title |
Endoscopic Diagnosis of Malignant Bile Duct Strictures |
| Author |
Tomoaki Matsumori |
Center for Gastroenterology, Teine-Keijinkai Hospital |
| Author |
Hiroyuki Maguchi |
Center for Gastroenterology, Teine-Keijinkai Hospital |
| Author |
Manabu Osanai |
Center for Gastroenterology, Teine-Keijinkai Hospital |
| Author |
Kuniyuki Takahashi |
Center for Gastroenterology, Teine-Keijinkai Hospital |
| Author |
Akio Katanuma |
Center for Gastroenterology, Teine-Keijinkai Hospital |
| Author |
Kei Yane |
Center for Gastroenterology, Teine-Keijinkai Hospital |
| [ Summary ] |
The primary form of examination to indicate the existence of malignant biliary strictures is imaging studies, such as abdominal US, CT, or MRCP. These examinations can reveal the primary tumor lesion and tumor growth. After these examinations, endoscopic procedures should be implemented for a detailed evaluation of the stricture and the tumor. The procedures primarily used in these cases are EUS and ERCP. IDUS and POCS may additionally be done for further evaluation. The advantages of endoscopic procedures are the production detailed images of the tumor, making a definitive diagnosis from tumor tissue samples, and obtaining a drainage route from the bile duct. EUS should be selected for middle to lower bile duct malignant strictures to differentiate the type of causative disease. POCS should be selected for cases in which bile duct cancer with superficial tumor extention is suspected.
On the other hand, IDUS and biopsies from stricture should be performed in cases in which the hilar segment of malignant bile duct stricture is involved and for operable cases. ENBD for the remnant liver lobe should also be conducted. After drainage, ENBD tube contrast results from the bile duct should be evaluated for longitudinal tumor extension. |