Factors affecting the yield of endoscopic transpapillary bile duct biopsy for the diagnosis of pancreatic head cancer

Background: Transpapillary biliary biopsy (TBB) is a simple endoscopic technique that can be performed during an initial biliary drainage session. This procedure has the potential to reduce the load of another tissue sampling in cases of pancreatic head cancer (PHC) with biliary stricture. The aim of this study is to identify factors associated with a positive outcome using TBB for PHC. Methods: In total, 130 cases that underwent TBB for investigation of distal biliary stricture were included [62 cases of PHC, 36 cases of distal biliary cancer (DBC), and 32 cases of benign biliary stricture (BBS)]. Factors affecting the diagnostic efficiency of TBB were determined using univariate and multivariate logistic analyses. Results: Cancer tissue was obtained in 31 cases (50%) of PHC and 33 cases (91.7%) of DBC. Multivariable analysis showed that >= 10 mg/dl of serum bilirubin level (odds ratio [OR]: 5.58; 95% confidence interval [CI]: 1.29-2820; P = 0.021) and >= 3 tissue samplings (OR: 3.59; 95% CI: 1.02-14.27, P = 0.046) were independent factors affecting cancer-positive rate in cases of PHC. In >90% of resected cases of PHC, cancer involved the left side of the biliary mucosa and the range of cancer invasion (>= 2/3 of circumference of biliary mucosa) was also a significant factor (P = 0.001). Conclusions: PHC showing high level of serum bilirubin (>10 mg/dl) and high circumferential proportion of bile duct invasion (>2/3 judging from MDCT) is a good indication for biliary biopsy. Targeting the leftside wall and >= 3 tissue samplings will lead to the higher sensitivity. Copyright (C) 2013, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved.