Diagnosis of Indeterminate Biliary Strictures using Ultrasonography Endoscope

Abstract

Background: Previously, the decision to operate has traditionally been made on the basis of clinical history and cholangiographic appearance of the stricture and sometimes empiric resection was necessary to differentiate benign and malignant strictures. However, determining the cause of a stricture on the basis of morphologic features and brush cytology is unreliable.              EUS  provides a high-resolution imaging modality that has evolved not only as a diagnostic tool but also as a therapeutic and interventional procedure. Since EUS is now the first choice in screening for small pancreatic tumors that cannot be detected by other imaging modalities and is not associated with ERCP-related complications, its utility for differentiating malignant and benign biliary strictures thus warrants more discussion. EUS provides the ability to identify a mass lesion not detected by other imaging modalities and enables high-definition imaging of stricture morphology. In addition, it facilitates staging by assessing regional lymphadenopathy and vascular involvement. Tissue acquisition using EUS-guided fine-needle aspiration (EUS-FNA) can also be performed.