ArticleEndoscopy2025
The value of cholangioscopy-guided bite-on-bite (-on bite) biopsies in indeterminate biliary duct strictures.
Article in Endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Advances in Diagnosis and Treatment With Cholangiopancreatoscopy.Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society · 2026Review
- Evolving techniques to optimize ERCP-based sampling and evaluation of malignant biliary strictures.Gastroenterology report · 2026Review
- Mapping malignancy: Multicenter study addressing topographic challenges in biliary stricture artificial intelligence analysis.Endoscopy international open · 2026Article
- Two scopes, one mission: An integrated approach of endoscopic retrograde cholangiopancreatography and endoscopic ultrasound to biliary strictures.World journal of gastroenterology · 2025Review
- A modified tetra-bite-on-bite biopsy technique under cholangioscopic guidance for biliary disease.Endoscopy · 2025Article
- Review
- Yield of next-generation sequencing in diagnostic work up of suspicious biliary strictures.Endoscopy international open · 2025Article
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Authors and funding
26 authors.
Funding
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Abstract
backgroundDigital single-operator cholangioscopy (dSOC) has improved the diagnostic accuracy of indeterminate biliary duct strictures (IBDS) through targeted intraductal biopsy sampling. However, the optimal biopsy technique remains uncertain.
methodsThis international, multicenter, prospective interventional study (November 2020-August 2022) included patients with IBDS undergoing dSOC. Stricture sampling involved obtaining at least four single biopsies and at least one bite-on-bite biopsy (BBB) in all patients. Definitive diagnosis was established by pathology outcomes and 1-year clinical follow-up. The primary outcome was the accuracy of both biopsy techniques.
results89 patients were included, with 76 hilar strictures and 13 distal strictures. Technical success for obtaining adequate tissue samples was 82/89 (92.1 %) for single biopsies and 78/89 (87.6 %) for BBB. Malignancy was confirmed in 31/82 (37.8 %) and 29/78 (37.2 %) cases in single biopsies and BBB, respectively. Among 76 patients in whom both techniques were successful, pathology results were discordant in three cases (3.9 %), primarily due to understaging by BBB. Among 82 patients with complete follow-up, malignancy was confirmed in 51 (62.2 %). Sensitivity, specificity, and accuracy for malignancy or high grade dysplasia were 66.0 %, 100 %, and 78.8 % for single biopsies, and 63.8 %, 100 %, and 77.6 % for BBB, respectively. Sensitivity and accuracy were significantly decreased after stent placement or intraductal tissue acquisition during prior ERCP. The number of BBBs did not impact sensitivity or accuracy.
conclusionsBBB did not outperform at least four single biopsies for IBDS. Prior manipulation of IBDS, through stent placement or prior tissue acquisition, was associated with a decreased diagnostic yield.
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