Challenging biliary strictures: pathophysiological features, differential diagnosis, diagnostic algorithms, and new clinically relevant biomarkers - part 1

Jean-Marc Dumonceau, Myriam Delhaye, Nicolas Charette, Annarita Farina, Jean-Marc Dumonceau, Myriam Delhaye, Nicolas Charette, Annarita Farina

Abstract

It is frequently challenging to make the correct diagnosis in patients with biliary strictures. This is particularly important as errors may have disastrous consequences. Benign-appearing strictures treated with stents may later be revealed to be malignant and unnecessary surgery for benign strictures carries a high morbidity rate. In the first part of the review, the essential information that clinicians need to know about diseases responsible for biliary strictures is presented, with a focus on the most recent data. Then, the characteristics and pitfalls of the methods used to make the diagnosis are summarized. These include serum biomarkers, imaging studies, and endoscopic modalities. As tissue diagnosis is the only 100% specific tool, it is described in detail, including techniques for tissue acquisition and their yields, how to prepare samples, and what to expect from the pathologist. Tricks to increase diagnostic yields are described. Clues are then presented for the differential diagnosis between primary and secondary sclerosing cholangitis, IgG4-related sclerosing cholangitis, cholangiocarcinoma, pancreatic cancer, autoimmune pancreatitis, and less frequent diseases. Finally, algorithms that will help to achieve the correct diagnosis are proposed.

Keywords: CA19-9; CEA; ERCP; biliary obstruction; biliary stenosis; cholangiocarcinoma; cholangiopathy; cholangitis; cholestasis; pancreatic cancer; pancreatitis.

Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

© The Author(s), 2020.

Figures

Figure 1.
Figure 1.
Algorithm for the evaluation of patients with a cholestatic clinical pattern caused by biliary stricture(s). The first step is to identify biliary stricture(s) by imaging procedures. The next step is to characterize the stricture(s). (a)Cholestatic clinical patterns include one or more of pruritus, dark urine, light stool, jaundice, increased serum levels of alkaline phosphatase, γ glutamyl transferase, bilirubin. (b)Particularly for the high-risk phenotype of PSC, that is, patients with large-duct PSC and ulcerative colitis as well as older patients, but not for patients with small-duct PSC or patients <20 years old. (c)Pruritus, jaundice, bacterial cholangitis, weight loss. (d)⩾20% increase in cholestatic liver enzymes (alkaline phosphatases, γ glutamyl transferase). a FP, alpha-fetoprotein; AIDS, acquired immune deficiency syndrome; CCA, cholangiocarcinoma; CT, computed tomography; ERCP, endoscopic retrograde cholangiopancreatography; IgG4-SC, IgG4-related sclerosing cholangitis; LT, liver transplantation; m: months; MRCP, magnetic resonance cholangiopancreatography; MRI, magnetic resonance imaging; PSC, primary sclerosing cholangitis; SOC, single operator cholangioscopy; US, ultrasonography.
Figure 2.
Figure 2.
Algorithm for the evaluation of indeterminate biliary strictures. Note that surgery may be indicated in some patients before completing all the steps. (a)Indeterminate biliary stricture(s) should be considered malignant (approximately 70% of cases) unless reasonably proven otherwise. In favor of a malignant biliary stricture: duct hyperenhancement and thickness ⩾3, 4, or 5 mm, adjacent lymph node enlargement >1 cm, vessels occlusion/encasement. In favor of a benign biliary stricture: smooth and gradual tapering of the bile duct, concentric narrowing. (b)Dilatation of both the common bile duct and the main pancreatic duct. (c)To identify a mass, bile duct wall thickening or adjacent lymph nodes. In patients who are candidates for LT, EUS-guided sampling of a hilar mass should be avoided because of concerns for tumor seeding. (d)HISORt criteria for IgG4-SC include (1) diagnostic histology and/or >10 IgG4-positive plasma cells/high-power field on immunostaining of ampullary or bile duct sampling, or (2) characteristic biliary imaging findings on CT-scan and MRI with elevated serum IgG4 level, or (3) indeterminate biliary stricture(s) after negative work up for known aetiologies including cancer, and elevated serum IgG4 levels and/or other organ involvement confirmed by presence of abundant IgG4-positive plasma cells, and response to steroid therapy of pancreatic/extrapancreatic manifestations of IgG4-related disease. (e)For patients with low levels of serum CA19-9 (despite suspicion of cancer), consider adding the dosage of serum CEA (and possibly CA125) to counterbalance the false-negative rate in patients in the negative Lewis blood group. AIP, autoimmune pancreatitis; CA19-9, carbohydrate antigen 19-9; CA125, cancer antigen 125; CCA, cholangiocarcinoma; CEA, carcinoembryonic antigen; CT, computed tomography; ERCP, endoscopic retrograde cholangiopancreatography; EUS, endoscopic ultrasonography; IgG4-SC, IgG4-related sclerosing cholangitis; LT, liver transplantation; MRI, magnetic resonance imaging.
Figure 3.
Figure 3.
A 31-year-old man with severe ulcerative pancolitis and primary sclerosing cholangitis. MRCP demonstrates diffuse irregularities of the common bile duct and intrahepatic bile ducts with multifocal strictures and mild upstream dilatation. MRCP, magnetic resonance cholangiopancreatography.
Figure 4.
Figure 4.
A 30-year-old Vietnamese woman with acute cholangitis, septicaemia, and shock. MRCP (A) shows a major dilatation of the right posterior intrahepatic bile duct filled with large stones and lithogenic material. Coronal MR T2-weighted image (B) shows a multilocular abscess of segment VII of the liver (arrow). Diagnosis was recurrent pyogenic cholangitis (oriental cholangitis). MRCP, magnetic resonance cholangiopancreatography.
Figure 5.
Figure 5.
Types of biliary strictures in IgG4-SC. Type 1: isolated stricture of the distal common bile duct. Type 2: diffuse strictures of the intra- and extra-hepatic bile ducts with (Type 2a) or without (Type 2b) prestenotic dilatation. Type 3: hilar stricture and distal common bile duct stricture. Type 4: isolated hilar stricture. Reproduced from Kamisawa et al. IgG4-SC, IgG4-related sclerosing cholangitis.
Figure 6.
Figure 6.
A 36-year-old man with asthenia, abdominal pain, and pruritus. Coronal MR T2-weighted image (A) and contrast-enhanced MR T1-weighted image (B) show multifocal smooth strictures of the common bile duct (arrows) because of extrinsic compression by a portal cavernoma (B, arrow) developed secondary to an extrahepatic portal stenosis. Diagnosis was primary myelofibrosis associated with portal hypertensive cholangiopathy. MR, magnetic resonance.
Figure 7.
Figure 7.
A 36-year-old man with recurrent abdominal pain and fever. AIDS had been diagnosed 12 years previously and treated episodically with antiretroviral drugs. Coronal MR T2-weighted image (A) and endoscopic cholangiogram (B) show focal distal common bile duct stricture (arrow) with mild upstream dilatation. Diagnosis was AIDS-associated cholangiopathy. AIDS, acquired immunodeficiency syndrome; MR, magnetic resonance
Figure 8.
Figure 8.
A 76-year-old man with painless obstructive jaundice, increased bilirubin (6 mg/dl, normal values

Figure 9.

Post-cholecystectomy stricture of an aberrant…

Figure 9.

Post-cholecystectomy stricture of an aberrant right posterior biliary duct (low insertion on the…

Figure 9.
Post-cholecystectomy stricture of an aberrant right posterior biliary duct (low insertion on the common bile duct) shown on 2D-MRCP (A, arrow) and endoscopic cholangiogram (B, arrow). MRCP, magnetic resonance cholangiopancreatography.

Figure 10.

A 62-year-old woman with cholestasis…

Figure 10.

A 62-year-old woman with cholestasis 8 months after liver transplantation for hepatocellular carcinoma…

Figure 10.
A 62-year-old woman with cholestasis 8 months after liver transplantation for hepatocellular carcinoma developed cirrhosis related to hepatitis C virus. 2D-MRCP discloses a long stricture extending from the anastomotic site to the hilar confluence (arrow) with upstream biliary dilatation. Diagnosis was ischaemic biliary stricture. MRCP, magnetic resonance cholangiopancreatography.

Figure 11.

A 48-year-old man with painless…

Figure 11.

A 48-year-old man with painless obstructive jaundice, loss of weight, and increased CA19-9…

Figure 11.
A 48-year-old man with painless obstructive jaundice, loss of weight, and increased CA19-9 serum level (14,000 U/l, normal values

Figure 12.

A 74-year-old man with cholestasis,…

Figure 12.

A 74-year-old man with cholestasis, loss of weight, and increased CA19-9 serum level…

Figure 12.
A 74-year-old man with cholestasis, loss of weight, and increased CA19-9 serum level (190 U/l, normal values 2-weighted image (A) and 2D-MRCP (B) show a long common bile duct stricture with upstream dilatation and no mass. After a 2-week negative steroid trial, the patient underwent surgery and pathological analysis revealed a T2N0 cholangiocarcinoma. CT, computed tomography; MRCP, magnetic resonance cholangiopancreatography.
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References
    1. Shanbhogue AK, Tirumani SH, Prasad SR, et al. Benign biliary strictures: a current comprehensive clinical and imaging review. Am J Roentgenol 2011; 197: W295–W306. - PubMed
    1. Bowlus CL, Olson KA, Gershwin ME. Evaluation of indeterminate biliary strictures. Nat Rev Gastroenterol Hepatol 2016; 13: 28–37. - PubMed
    1. Liang B, Zhong L, He Q, et al. Diagnostic accuracy of serum CA19-9 in patients with cholangiocarcinoma: a systematic review and meta-analysis. Med Sci Monitor 2015; 21: 3555–3563. - PMC - PubMed
    1. Zhang Y, Yang J, Li H, et al. Tumor markers CA19-9, CA242 and CEA in the diagnosis of pancreatic cancer: a meta-analysis. Int J Clin Exp Med 2015; 8: 11683–11691. - PMC - PubMed
    1. Yu XR, Huang WY, Zhang BY, et al. Differentiation of infiltrative cholangiocarcinoma from benign common bile duct stricture using three-dimensional dynamic contrast-enhanced MRI with MRCP. Clin Radiol 2014; 69: 567–573. - PubMed
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Figure 9.
Figure 9.
Post-cholecystectomy stricture of an aberrant right posterior biliary duct (low insertion on the common bile duct) shown on 2D-MRCP (A, arrow) and endoscopic cholangiogram (B, arrow). MRCP, magnetic resonance cholangiopancreatography.
Figure 10.
Figure 10.
A 62-year-old woman with cholestasis 8 months after liver transplantation for hepatocellular carcinoma developed cirrhosis related to hepatitis C virus. 2D-MRCP discloses a long stricture extending from the anastomotic site to the hilar confluence (arrow) with upstream biliary dilatation. Diagnosis was ischaemic biliary stricture. MRCP, magnetic resonance cholangiopancreatography.
Figure 11.
Figure 11.
A 48-year-old man with painless obstructive jaundice, loss of weight, and increased CA19-9 serum level (14,000 U/l, normal values

Figure 12.

A 74-year-old man with cholestasis,…

Figure 12.

A 74-year-old man with cholestasis, loss of weight, and increased CA19-9 serum level…

Figure 12.
A 74-year-old man with cholestasis, loss of weight, and increased CA19-9 serum level (190 U/l, normal values 2-weighted image (A) and 2D-MRCP (B) show a long common bile duct stricture with upstream dilatation and no mass. After a 2-week negative steroid trial, the patient underwent surgery and pathological analysis revealed a T2N0 cholangiocarcinoma. CT, computed tomography; MRCP, magnetic resonance cholangiopancreatography.
All figures (12)
Figure 12.
Figure 12.
A 74-year-old man with cholestasis, loss of weight, and increased CA19-9 serum level (190 U/l, normal values 2-weighted image (A) and 2D-MRCP (B) show a long common bile duct stricture with upstream dilatation and no mass. After a 2-week negative steroid trial, the patient underwent surgery and pathological analysis revealed a T2N0 cholangiocarcinoma. CT, computed tomography; MRCP, magnetic resonance cholangiopancreatography.

References

    1. Shanbhogue AK, Tirumani SH, Prasad SR, et al. Benign biliary strictures: a current comprehensive clinical and imaging review. Am J Roentgenol 2011; 197: W295–W306.
    1. Bowlus CL, Olson KA, Gershwin ME. Evaluation of indeterminate biliary strictures. Nat Rev Gastroenterol Hepatol 2016; 13: 28–37.
    1. Liang B, Zhong L, He Q, et al. Diagnostic accuracy of serum CA19-9 in patients with cholangiocarcinoma: a systematic review and meta-analysis. Med Sci Monitor 2015; 21: 3555–3563.
    1. Zhang Y, Yang J, Li H, et al. Tumor markers CA19-9, CA242 and CEA in the diagnosis of pancreatic cancer: a meta-analysis. Int J Clin Exp Med 2015; 8: 11683–11691.
    1. Yu XR, Huang WY, Zhang BY, et al. Differentiation of infiltrative cholangiocarcinoma from benign common bile duct stricture using three-dimensional dynamic contrast-enhanced MRI with MRCP. Clin Radiol 2014; 69: 567–573.
    1. Ghazale A, Chari ST, Zhang L, et al. Immunoglobulin G4–associated cholangitis: clinical profile and response to therapy. Gastroenterology 2008; 134: 706–715.
    1. Lazaridis KN, Larusso NF. Primary sclerosing cholangitis. N Engl J Med 2016; 375: 1161–1170.
    1. Dyson JK, Beuers U, Jones DEJ, et al. Primary sclerosing cholangitis. Lancet 2018; 391: 2547–2559.
    1. Chapman MH, Thorburn D, Hirschfield GM, et al. British society of gastroenterology and UK-PSC guidelines for the diagnosis and management of primary sclerosing cholangitis. Gut 2019; 68: 1356–1378.
    1. Broome U, Olsson R, Loof L, et al. Natural history and prognostic factors in 305 Swedish patients with primary sclerosing cholangitis. Gut 1996; 38: 610–615.
    1. Said K, Glaumann H, Bergquist A. Gallbladder disease in patients with primary sclerosing cholangitis. J Hepatol 2008; 48: 598–605.
    1. Stiehl A, Rudolph G, Klöters-Plachky P, et al. Development of dominant bile duct stenoses in patients with primary sclerosing cholangitis treated with ursodeoxycholic acid: outcome after endoscopic treatment. J Hepatol 2002; 36: 151–156.
    1. Bjornsson E, Lindqvist-Ottosson J, Asztely M, et al. Dominant strictures in patients with primary sclerosing cholangitis. Am J Gastroenterol 2004; 99: 502–508.
    1. Chapman MH, Webster GJ, Bannoo S, et al. Cholangiocarcinoma and dominant strictures in patients with primary sclerosing cholangitis: a 25-year single-centre experience. Eur J Gastroenterol Hepatol 2012; 24: 1051–1058.
    1. Aabakken L, Karlsen TH, Albert J, et al. Role of endoscopy in primary sclerosing cholangitis: European society of gastrointestinal endoscopy (ESGE) and European association for the study of the liver (EASL) clinical guideline. Endoscopy 2017; 49: 588–608.
    1. Angulo P, Maor-Kendler Y, Lindor KD. Small–duct primary sclerosing cholangitis: a long-term follow-up study. Hepatology 2002; 35: 1494–1500.
    1. Weismüller TJ, Trivedi PJ, Bergquist A, et al. Patient age, sex, and inflammatory bowel disease phenotype associate with course of primary sclerosing cholangitis. Gastroenterology 2017; 152: 1975–1984e1978.
    1. Boonstra K, Weersma RK, Van Erpecum KJ, et al. Population-based epidemiology, malignancy risk, and outcome of primary sclerosing cholangitis. Hepatology 2013; 58: 2045–2055.
    1. Razumilava N, Gores GJ. Surveillance for cholangiocarcinoma in patients with primary sclerosing cholangitis: effective and justified? Clin Liver Dis (Hoboken) 2016; 8: 43–47.
    1. Njei B, Mccarty TR, Varadarajulu S, et al. Cost utility of ERCP-based modalities for the diagnosis of cholangiocarcinoma in primary sclerosing cholangitis. Gastrointest Endosc 2017; 85: 773–781e710.
    1. Chalasani N, Baluyut A, Ismail A, et al. Cholangiocarcinoma in patients with primary sclerosing cholangitis: a multicenter case-control study. Hepatology 2000; 31: 7–11.
    1. Haseeb A, Siddiqui A, Taylor LJ, et al. Elevated serum bilirubin level correlates with the development of cholangiocarcinoma, subsequent liver transplantation, and death in patients with primary sclerosing cholangitis. J Clin Gastroenterol: 2016; 50: 431–435.
    1. Zheng HH, Jiang XL. Increased risk of colorectal neoplasia in patients with primary sclerosing cholangitis and inflammatory bowel disease: a meta-analysis of 16 observational studies. Eur J Gastroenterol Hepatol 2016; 28: 383–390.
    1. Sørensen JØ, Nielsen OH, Andersson M, et al. Inflammatory bowel disease with primary sclerosing cholangitis: a Danish population-based cohort study 1977-2011. Liver Int 2018; 38: 532–541.
    1. Eaton JE, Talwalkar JA, Lazaridis KN, et al. Pathogenesis of primary sclerosing cholangitis and advances in diagnosis and management. Gastroenterology 2013; 145: 521–536.
    1. European Association for the Study of the Liver. EASL clinical practice guidelines: management of cholestatic liver diseases. J Hepatol 2009; 51: 237–267.
    1. Chapman R, Fevery J, Kalloo A, et al. Diagnosis and management of primary sclerosing cholangitis. Hepatology 2010; 51: 660–667.
    1. Wiles R, Thoeni RF, Barbu ST, et al. Management and follow-up of gallbladder polyps: joint guidelines between the European society of gastrointestinal and abdominal radiology (ESGAR), European association for endoscopic surgery and other interventional techniques (EAES), international society of digestive surgery – European federation (EFISDS) and European society of gastrointestinal endoscopy (ESGE). Eur Radiol 2017; 27: 3856–3866.
    1. Angulo P, Grandison GA, Fong DG, et al. Bone disease in patients with primary sclerosing cholangitis. Gastroenterology 2011; 140: 180–188.
    1. Ponsioen C, Reitsma J, Boberg K, et al. Validation of a cholangiographic prognostic model in primary sclerosing cholangitis. Endoscopy 2010; 42: 742–747.
    1. Kamisawa T, Nakazawa T, Tazuma S, et al. Clinical practice guidelines for IgG4-related sclerosing cholangitis. J Hepatobiliary Pancreat Sci 2019; 26: 9–42.
    1. Berstad A, Aabakken L, Smith H, et al. Diagnostic accuracy of magnetic resonance and endoscopic retrograde cholangiography in primary sclerosing cholangitis. Clin Gastroenterol Hepatol 2006; 4: 514–520.
    1. Dave M, Elmunzer BJ, Dwamena BA, et al. Primary sclerosing cholangitis: meta-analysis of diagnostic performance of MR cholangiopancreatography. Radiology 2010; 256: 387–396.
    1. Gleeson F, Rajan E, Levy M, et al. EUS-guided FNA of regional lymph nodes in patients with unresectable hilar cholangiocarcinoma. Gastrointest Endosc 2008; 67: 438–443.
    1. Razumilava N, Gleeson FC, Gores GJ. Awareness of tract seeding with endoscopic ultrasound tissue acquisition in perihilar cholangiocarcinoma. Am J Gastroenterol 2015; 110: 200.
    1. Rizvi S, Eaton JE, Gores GJ. Primary sclerosing cholangitis as a premalignant biliary tract disease: surveillance and management. Clin Gastroenterol Hepatol 2015; 13: 2152–2165.
    1. Laurence JM, Greig PD. Recurrent pyogenic cholangitis. In: Dixon E, Vollmer CM, May GR. (eds), Management of benign biliary stenosis and injury. Cham: Springer International Publishing, 2015.
    1. Kwan KEL, Shelat VG, Tan CH. Recurrent pyogenic cholangitis: a review of imaging findings and clinical management. Abdom Radiol (NY) 2017; 42: 46–56.
    1. Culver EL, Chapman RW. IgG4-related hepatobiliary disease: an overview. Nat Rev Gastroenterol Hepatol 2016; 13: 601–612.
    1. Du S, Liu G, Cheng X, et al. Differential diagnosis of immunoglobulin G4-associated cholangitis from cholangiocarcinoma. J Clin Gastroenterol 2016; 50: 501–505.
    1. Van Heerde MJ, Buijs J, Hansen BE, et al. Serum level of CA 19-9 increases ability of IgG4 test to distinguish patients with autoimmune pancreatitis from those with pancreatic carcinoma. Dig Dis Sci 2014; 59: 1322–1329.
    1. Chari ST, Smyrk TC, Levy MJ, et al. Diagnosis of autoimmune pancreatitis: the mayo clinic experience. Clin Gastroenterol Hepatol 2006; 4: 1010–1016.
    1. Tokala A, Khalili K, Menezes R, et al. Comparative MRI analysis of morphologic patterns of bile duct disease in IgG4-related systemic disease versus primary sclerosing cholangitis. Am J Roentgenol 2014; 202: 536–543.
    1. Sarma MS, Yachha SK, Chaudhary A. Portal biliopathy. In: Barreto SG, Windsor JA. (eds) Surgical diseases of the pancreas and biliary tree. Singapore: Springer Singapore; 2018.
    1. Abdalian R, Heathcote EJ. Sclerosing cholangitis: a focus on secondary causes. Hepatology 2006; 44: 1063–1074.
    1. Naseer M, Dailey FE, Juboori AA, et al. Epidemiology, determinants, and management of AIDS cholangiopathy: a review. World J Gastroenterol 2018; 24: 767–774.
    1. Gudnason HO, Björnsson ES. Secondary sclerosing cholangitis in critically ill patients: current perspectives. Clin Exp Gastroenterol 2017; 10: 105–111.
    1. Abdallah AA, Krige JE, Bornman PC. Biliary tract obstruction in chronic pancreatitis. HPB (Oxford) 2007; 9: 421–428.
    1. Kamat R, Gupta P, Rana S. Imaging in chronic pancreatitis: state of the art review. Indian J Radiol Imaging 2019; 29: 201–210.
    1. Majumder S, Takahashi N, Chari ST. Autoimmune pancreatitis. Dig Dis Sci 2017; 62: 1762–1769.
    1. Miyabe K, Zen Y, Cornell LD, et al. Gastrointestinal and extra-intestinal manifestations of IgG4–related disease. Gastroenterol 2018; 155: 990–1003e1001.
    1. Lopes Vendrami C, Shin JS, Hammond NA, et al. Differentiation of focal autoimmune pancreatitis from pancreatic ductal adenocarcinoma. Abdom Radiol (NY) 2019; 45: 1371–1386.
    1. Arvanitakis M, Van Laethem JL, Parma J, et al. Predictive factors for pancreatic cancer in patients with chronic pancreatitis in association with K-ras gene mutation. Endoscopy 2004; 36: 535–542.
    1. Kirkegård J, Mortensen FV, Cronin-Fenton D. Chronic pancreatitis and pancreatic cancer risk: a systematic review and meta-analysis. Am J Gastroenterol 2017; 112: 1366–1372.
    1. Niu X, Das SK, Bhetuwal A, et al. Value of diffusion-weighted imaging in distinguishing pancreatic carcinoma from mass-forming chronic pancreatitis: a meta-analysis. Chin Med J (Engl) 2014; 127: 3477–3482.
    1. Halbert C, Pagkratis S, Yang J, et al. Beyond the learning curve: incidence of bile duct injuries following laparoscopic cholecystectomy normalize to open in the modern era. Surg Endosc 2016; 30: 2239–2243.
    1. Schreuder AM, Busch OR, Besselink MG, et al. Long-term impact of iatrogenic bile duct injury. Dig Surg 2020; 37: 10–21.
    1. Chun K. Recent classifications of the common bile duct injury. Korean J Hepatobiliary Pancreat Surg 2014; 18: 69–72.
    1. Bali MA, Pezzullo M, Pace E, et al. Benign biliary diseases. Eur J Radiol 2017; 93: 217–228.
    1. Moy BT, Birk JW. A review on the management of biliary complications after orthotopic liver transplantation. J Clin Translat Hepatol 2019; 7: 1–11.
    1. Macias Gomez C, Dumonceau JM. Endoscopic management of biliary complications after liver transplantation: an evidence-based review. World J Gastrointest Endosc 2015; 7: 606–616.
    1. Hildebrand T, Pannicke N, Dechene A, et al. Biliary strictures and recurrence after liver transplantation for primary sclerosing cholangitis: a retrospective multicenter analysis: biliary strictures and PSC recurrence. Liver Transpl 2016; 22: 42–52.
    1. Chang JH, Lee IS, Choi JY, et al. Biliary stricture after adult right-lobe living-donor liver transplantation with duct-to-duct anastomosis: long-term outcome and its related factors after endoscopic treatment. Gut Liver 2010; 4: 226–233.
    1. Mirizzi PL. Syndrome of spontaneous hepatic duct. Dia Med 1958; 30: 30 passim.
    1. Alemi F, Seiser N, Ayloo S. Gallstone disease. Surg Clin North Am 2019; 99: 231–244.
    1. Yun EJ, Choi CS, Yoon DY, et al. Combination of magnetic resonance cholangiopancreatography and computed tomography for preoperative diagnosis of the mirizzi syndrome. J Comput Assist Tomogr 2009; 33: 636–640.
    1. Csendes A, Diaz JC, Burdiles P, et al. Mirizzi syndrome and cholecystobiliary fistula: a unifying classification. Br J Surg 1989; 76: 1139–1143.
    1. Tombazzi C, Waters B, Ismail MK, et al. Sarcoidosis mimicking primary sclerosing cholangitis requiring liver transplantation. Ann Hepatol 2008; 7: 83–86.
    1. Genevay M, Frossard JL, Huber O, et al. High-grade common bile duct stricture caused by diffuse adenomyomatosis. Gastrointest Endosc 2009; 69: 1167–1168.
    1. Heller MT, Borhani AA, Furlan A, et al. Biliary strictures and masses: an expanded differential diagnosis. Abdom Imaging 2015; 40: 1944–1960.
    1. Nguyen Canh H, Harada K. Adult bile duct strictures: differentiating benign biliary stenosis from cholangiocarcinoma. Med Mol Morphol 2016; 49: 189–202.
    1. Rawla P, Sunkara T, Gaduputi V. Epidemiology of pancreatic cancer: global trends, etiology and risk factors. World J Oncol 2019; 10: 10–27.
    1. Midha S, Chawla S, Garg PK. Modifiable and non-modifiable risk factors for pancreatic cancer: a review. Cancer Lett 2016; 381: 269–277.
    1. Ryan DP, Hong TS, Bardeesy N. Pancreatic adenocarcinoma. N Engl J Med 2014; 371: 1039–1049.
    1. Cignarelli A, Genchi VA, Caruso I, et al. Diabetes and cancer: pathophysiological fundamentals of a ‘dangerous affair’. Diabetes Res Clin Pract 2018; 143: 378–388.
    1. Toft J, Hadden WJ, Laurence JM, et al. Imaging modalities in the diagnosis of pancreatic adenocarcinoma: a systematic review and meta-analysis of sensitivity, specificity and diagnostic accuracy. Eur J Radiol 2017; 92: 17–23.
    1. Tempero MA, Malafa MP, Al-Hawary M, et al. Pancreatic adenocarcinoma, version 2.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2017; 15: 1028–1061.
    1. Khorana AA, Mckernin SE, Berlin J, et al. Potentially curable pancreatic adenocarcinoma: ASCO clinical practice guideline update. J Clin Oncol 2019; 37: 2082–2088.
    1. Schick V, Franzius C, Beyna T, et al. Diagnostic impact of 18F-FDG PET–CT evaluating solid pancreatic lesions versus endosonography, endoscopic retrograde cholangio-pancreatography with intraductal ultrasonography and abdominal ultrasound. Eur J Nucl Med Mol Imaging 2008; 35: 1775–1785.
    1. Zhang J, Jia G, Zuo C, et al. 18F- FDG PET/CT helps differentiate autoimmune pancreatitis from pancreatic cancer. BMC Cancer 2017; 17: 695.
    1. Dai C, Cao Q, Jiang M, et al. Serum immunoglobulin G4 in discriminating autoimmune pancreatitis from pancreatic cancer: a diagnostic meta-analysis. Pancreas: 2018; 47: 280–284
    1. Patel N, Benipal B. Incidence of cholangiocarcinoma in the USA from 2001 to 2015: a US cancer statistics analysis of 50 states. Cureus 2019; 11: e3962.
    1. Nakeeb A, Pitt HA, Sohn TA, et al. Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors. Ann Surg 1996; 224: 463–473.
    1. Deoliveira ML, Cunningham SC, Cameron JL, et al. Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg 2007; 245: 755–762.
    1. Yamasaki S. Intrahepatic cholangiocarcinoma: macroscopic type and stage classification. J Hepatobiliary Pancreat Surg 2003; 10: 288–291.
    1. Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet 1975; 140: 170–178.
    1. Banales JM, Cardinale V, Carpino G, et al. Cholangiocarcinoma: current knowledge and future perspectives consensus statement from the European network for the study of cholangiocarcinoma (ENS-CCA). Nat Rev Gastroenterol Hepatol 2016; 13: 261–280.
    1. Esnaola NF, Meyer JE, Karachristos A, et al. Evaluation and management of intrahepatic and extrahepatic cholangiocarcinoma: management of cholangiocarcinoma. Cancer 2016; 122: 1349–1369.
    1. Van Beers BE. Diagnosis of Cholangiocarcinoma. HPB (Oxford) 2008; 10: 87–93.
    1. Cai Y, Cheng N, Ye H, et al. The current management of cholangiocarcinoma: a comparison of current guidelines. Biosci Trends 2016; 10: 92–102.
    1. Romagnuolo J, Bardou M, Rahme E, et al. Magnetic resonance cholangiopancreatography: a meta-analysis of test performance in suspected biliary disease. Ann Intern Med 2003; 139: 547–557.
    1. Olthof SC, Othman A, Clasen S, et al. Imaging of cholangiocarcinoma. Visc Med 2016; 32: 402–410.
    1. Kim SY. Preoperative radiologic evaluation of cholangiocarcinoma. Korean J Gastroenterol 2017; 69: 159–163.
    1. Annunziata S, Caldarella C, Pizzuto DA, et al. Diagnostic accuracy of fluorine-18-fluorodeoxyglucose positron emission tomography in the evaluation of the primary tumor in patients with cholangiocarcinoma: a meta-analysis. Biomed Res Int 2014; 2014: 1–13.
    1. Frossard JL, Dumonceau JM. The role of EUS in the biliary system. In: Shami and Kahaleh(eds) Endoscopic Ultrasound, New York: Springer, 2020, pp. 1–547.
    1. Tringali A, Lemmers A, Meves V, et al. Intraductal biliopancreatic imaging: European society of gastrointestinal endoscopy (ESGE) technology review. Endoscopy 2015; 47: 739–753.
    1. Kim HS, Moon JH, Lee YN, et al. Prospective comparison of intraductal ultrasonography-guided transpapillary biopsy and conventional biopsy on fluoroscopy in suspected malignant biliary strictures. Gut Liver 2018; 12: 463–470.
    1. Navaneethan U, Hasan MK, Lourdusamy V, et al. Single-operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate biliary strictures: a systematic review. Gastrointest Endosc 2015; 82: 608–614e602.
    1. Xu MM, Sethi A. Diagnosing biliary malignancy. Gastrointest Endosc Clin North Am 2015; 25: 677–690.
    1. Gao YD, Qu YW, Liu HF. Comparison of diagnostic efficacy between CLE, tissue sampling, and CLE combined with tissue sampling for undetermined pancreaticobiliary strictures: a meta-analysis. Scand J Gastroenterol 2018; 53: 482–489.
    1. Randi G, Malvezzi M, Levi F, et al. Epidemiology of biliary tract cancers: an update. Ann Oncol 2008; 20: 146–159.
    1. Rustagi T, Dasanu CA. Risk factors for gallbladder cancer and cholangiocarcinoma: similarities, differences and updates. J Gastrointest Cancer 43: 137–147.
    1. Wernberg JA, Lucarelli DD. Gallbladder cancer. Surg Clin North Am 2014; 94: 343–360.
    1. Kanthan R, Senger JL, Ahmed S, et al. Gallbladder cancer in the 21st century. J Oncol 2015; 2015: 1–26.
    1. Sandrasegaran K, Menias CO. Imaging and screening of cancer of the gallbladder and bile ducts. Radiol Clin North Am 2017; 55: 1211–1222.
    1. Xing H, Wang J, Wang Y, et al. Diagnostic value of CA 19-9 and carcinoembryonic antigen for pancreatic cancer: a meta-analysis. Gastroenterol Res Pract 2018; 2018: 8704751.
    1. Owens DK, Davidson KW, Krist AH, et al. Screening for pancreatic cancer: us preventive services task force reaffirmation recommendation statement. JAMA 2019; 322: 438.
    1. Lee SP, Sung IK, Kim JH, et al. Usefulness of carbohydrate antigen 19-9 test in healthy people and necessity of medical follow-up in individuals with elevated carbohydrate antigen 19-9 level. Korean J Fam Med 2019; 40: 314–322.
    1. Yachida S, Jones S, Bozic I, et al. Distant metastasis occurs late during the genetic evolution of pancreatic cancer. Nature 2010; 467: 1114–1117.
    1. Canto MI, Harinck F, Hruban RH, et al. International cancer of the pancreas screening (CAPS) consortium summit on the management of patients with increased risk for familial pancreatic cancer. Gut 2013; 62: 339–347.
    1. Langer P, Kann PH, Fendrich V, et al. Five years of prospective screening of high-risk individuals from families with familial pancreatic cancer. Gut 2009; 58: 1410–1418.
    1. Corral JE, Mareth KF, Riegert-Johnson DL, et al. Diagnostic yield from screening asymptomatic individuals at high risk for pancreatic cancer: a meta-analysis of cohort studies. Clin Gastroenterol Hepatol 2019; 17: 41–53.
    1. Illés D, Terzin V, Holzinger G, et al. New-onset type 2 diabetes mellitus – a high-risk group suitable for the screening of pancreatic cancer? Pancreatology 2016; 16: 266–271.
    1. Sharma A, Kandlakunta H, Nagpal SJS, et al. Model to determine risk of pancreatic cancer in patients with new-onset diabetes. Gastroenterology 2018; 155: 730–739e733.
    1. Wannhoff A, Gotthardt DN. Recent developments in the research on biomarkers of cholangiocarcinoma in primary sclerosing cholangitis. Clin Res Hepatol Gastroenterol 2019; 43: 236–243.
    1. Luo G, Liu C, Guo M, et al. Potential biomarkers in Lewis negative patients with pancreatic cancer. Ann Surg 2017; 265: 800–805.
    1. Riker A, Libutti SK, Bartlett DL. Advances in the early detection, diagnosis, and staging of pancreatic cancer. Surg Oncol 1997; 6: 157–169.
    1. Goonetilleke KS, Siriwardena AK. Systematic review of carbohydrate antigen (CA 19-9) as a biochemical marker in the diagnosis of pancreatic cancer. Eur J Surg Oncol 2007; 33: 266–270.
    1. Song J, Li Y, Bowlus CL, et al. Cholangiocarcinoma in patients with primary sclerosing cholangitis (PSC): a comprehensive review. Clin Rev Allergy & Immunol 2020; 58: 134–149
    1. Liu W, Liu Q, Wang W, et al. Differential diagnostic roles of the serum CA19-9, total bilirubin (TBIL) and the ratio of CA19-9 to TBIL for benign and malignant. J Cancer 2018; 9: 1804–1812.
    1. Cui L, Lv N, Li B, et al. Serum CA 19–9 level is correlated to the clinical characteristics and chronic complications of patients newly diagnosed with type 2 diabetes mellitus. Exp Clin Endocrinol Diabetes. Epub ahead of print 28 August 2019. DOI: 10.1055/a-0994-9970.
    1. Su SB. Carbohydrate antigen 19-9 for differential diagnosis of pancreatic carcinoma and chronic pancreatitis. World J Gastroenterol 2015; 21: 4323.
    1. Dumonceau JM, Delhaye M, Tringali A, et al. Endoscopic treatment of chronic pancreatitis: European society of gastrointestinal endoscopy (ESGE) guideline – updated August 2018. Endoscopy 2019; 51: 179–193.
    1. Santucci N, Facy O, Ortega-Deballon P, et al. CA 19–9 predicts resectability of pancreatic cancer even in jaundiced patients. Pancreatology 2018; 18: 666–670.
    1. Fang T, Wang H, Wang Y, et al. Clinical significance of preoperative serum CEA, CA125, and CA19-9 levels in predicting the resectability of cholangiocarcinoma. Dis Markers 2019; 2019: 1–7.
    1. Liu F, Wang JK, Ma WJ, et al. Clinical value of preoperative CA19-9 levels in evaluating resectability of gallbladder carcinoma. ANZ J Surg 2019; 89: E76–E80.
    1. Ferrone CR, Finkelstein DM, Thayer SP, et al. Perioperative CA19-9 levels can predict stage and survival in patients with resectable pancreatic adenocarcinoma. J Clin Oncol 2006; 24: 2897–2902.
    1. Macedo FI, Ryon E, Maithel SK, et al. Survival outcomes associated with clinical and pathological response following neoadjuvant folfirinox or gemcitabine/nab-paclitaxel chemotherapy in resected pancreatic cancer. Ann Surg 2019; 270: 400–413.
    1. Rocha Lima CM, Savarese D, Bruckner H, et al. Irinotecan plus gemcitabine induces both radiographic and CA 19-9 tumor marker responses in patients with previously untreated advanced pancreatic cancer. J Clin Oncol 20: 1182–1191.
    1. Loosen SH, Roderburg C, Kauertz KL, et al. CEA but not CA19-9 is an independent prognostic factor in patients undergoing resection of cholangiocarcinoma. Sci Rep 2017; 7: 16975.
    1. Sasaki K, Margonis GA, Andreatos N, et al. Serum tumor markers enhance the predictive power of the AJCC and LCSGI staging systems in resectable intrahepatic cholangiocarcinoma. HPB (Oxford) 2018; 20: 956–965.
    1. Navaneethan U, Njei B, Venkatesh PG, et al. Endoscopic ultrasound in the diagnosis of cholangiocarcinoma as the etiology of biliary strictures: a systematic review and meta-analysis. Gastroenterol Rep (Oxf) 2015; 3: 209–215.
    1. Dumonceau JM, Deprez PH, Jenssen C, et al. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European society of gastrointestinal endoscopy (ESGE) clinical guideline - updated January 2017. Endoscopy 2017; 49: 695–714.
    1. Dumonceau JM, Tringali A, Papanikolaou I, et al. Endoscopic biliary stenting: indications, choice of stents, and results: European society of gastrointestinal endoscopy (ESGE) clinical guideline – updated October 2017. Endoscopy 2018; 50: 910–930.
    1. Sethi R, Singh K, Warner B, et al. The impact of brush cytology from endoscopic retrograde cholangiopancreatography (ERCP) on patient management at a UK teaching hospital. Frontline Gastroenterol 2016; 7: 97–101.
    1. Tsuchiya T, Yokoyama Y, Ebata T, et al. Randomized controlled trial on timing and number of sampling for bile aspiration cytology. J Hepatobiliary Pancreat Sci 2014; 21: 433–438.
    1. Polkowski M, Jenssen C, Kaye P, et al. Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European society of gastrointestinal endoscopy (ESGE) technical guideline - March 2017. Endoscopy 2017; 49: 989–1006.
    1. Sugimoto S, Matsubayashi H, Kimura H, et al. Diagnosis of bile duct cancer by bile cytology: usefulness of post-brushing biliary lavage fluid. Endosc Int Open 2015; 3: E323–E328.
    1. Dumonceau JM, Casco C, Landoni N, et al. A new method of biliary sampling for cytopathological examination during endoscopic retrograde cholangiography. Am J Gastroenterol 2007; 102: 550–557.
    1. Dumonceau JM, Macias Gomez C, Casco C, et al. Grasp or brush for biliary sampling at endoscopic retrograde cholangiography? A blinded randomized controlled trial. Am J Gastroenterol 2008; 103: 333–340.
    1. Brand B, Thonke F, Obytz S, et al. Stent retriever for dilation of pancreatic and bile duct strictures. Endoscopy 1999; 31: 142–145.
    1. Alagappan M, Darras N, Yang L, et al. Yield of biliary stent cytology: is it time to think lean? Endosc Int Open 2019; 7: E545–E550.
    1. Sethi A, Chen YK, Austin GL, et al. ERCP with cholangiopancreatoscopy may be associated with higher rates of complications than ERCP alone: a single-center experience. Gastrointest Endosc 2011; 73: 251–256.
    1. Neuhaus H. New techniques for direct biliary visualization: do we need them and what can be achieved? Gastrointest Endosc 2011; 74: 317–320.
    1. Kocjan G, Chandra A, Cross P, et al. BSCC code of practice–fine needle aspiration cytology. Cytopathology 2009; 20: 283–296.
    1. Amog-Jones GF, Chandra S, Jensen C, et al. Including the sheath rinse to improve cellular yield in biliary brushing cytology. Clin Endosc 2017; 50: 614–616.
    1. Dumonceau JM, Koessler T, Van Hooft JE, et al. Endoscopic ultrasonography-guided fine needle aspiration: relatively low sensitivity in the endosonographer population. World J Gastroenterol 2012; 18: 2357–2363.
    1. Tamura T, Yamashita Y, Ueda K, et al. Rapid on-site evaluation by endosonographers during endoscopic ultrasonography-guided fine-needle aspiration for diagnosis of gastrointestinal stromal tumors. Clin Endosc 2017; 50: 372–378.
    1. Machado RS, Richa R, Callegari F, et al. Instant messenger smartphone application for endosonographer/cytopathologist real-time interaction at a distance in EUS-FNA for solid pancreatic lesions. Endosc Int Open 2019; 7: E1027–E1030.
    1. Wani S, Mullady D, Early DS, et al. The clinical impact of immediate on-site cytopathology evaluation during endoscopic ultrasound-guided fine needle aspiration of pancreatic masses: a prospective multicenter randomized controlled trial. Am J Gastroenterol 2015; 110: 1429–1439.
    1. Lee LS, Nieto J, Watson RR, et al. Randomized non-inferiority trial comparing diagnostic yield of cytopathologist-guided versus seven passes for endoscopic ultrasound-guided fine-needle aspiration of pancreatic masses: randomized trial EUS-FNA pancreatic mass. Dig Endosc 2016; 28: 469–475.
    1. Kawada N, Uehara H, Katayama K, et al. Combined brush cytology and stent placement in a single session for presumed malignant biliary stricture. J Gastroenterol Hepatol 2011; 26: 1247–1251.
    1. Wright ER, Bakis G, Srinivasan R, et al. Intraprocedural tissue diagnosis during ERCP employing a new cytology preparation of forceps biopsy (smash protocol). Am J Gastroenterol 2011; 106: 294–299.
    1. Ali S, Hawes RH, Kadkhodayan K, et al. Utility of rapid onsite evaluation of touch imprint cytology from endoscopic and cholangioscopic forceps biopsy sampling (with video). Gastrointest Endosc 2019; 89: 340–344.
    1. Pitman MB, Centeno BA, Ali SZ, et al. Standardized terminology and nomenclature for pancreatobiliary cytology: the papanicolaou society of cytopathology guidelines. Cytojournal 2014; 11(Suppl. 1): 3.
    1. Okonkwo AM, De Frias DV, Gunn R, et al. Reclassification of “atypical” diagnoses in endoscopic retrograde cholangiopancreaticography-guided biliary brushings. Acta Cytol 2003; 47: 435–442.
    1. López-Ramírez AN, Villegas-González LF, Serrano-Arévalo ML, et al. Reclassification of lesions in biopsies by fine-needle aspiration of pancreas and biliary tree using papanicolaou classification. J Gastrointest Oncol 2018; 9: 847–852.
    1. Hacihasanoglu E, Memis B, Pehlivanoglu B, et al. Factors impacting the performance characteristics of bile duct brushings: a clinico-cytopathologic analysis of 253 patients. Arch Pathol Lab Med 2018; 142: 863–870.
    1. Duggan MA, Brasher P, Medlicott SA. ERCP-directed brush cytology prepared by the thinprep method: test performance and morphology of 149 cases. Cytopathology 2004; 15: 80–86.
    1. Cibas ES, Ducatman BS. Cytology: diagnostic principles and clinical correlates, 2nd ed. London: Saunders Ltd, 2014.
    1. Wight CO, Zaitoun AM, Boulton-Jones JR, et al. Improving diagnostic yield of biliary brushings cytology for pancreatic cancer and cholangiocarcinoma. Cytopathology 2004; 15: 87–92.
    1. Brooks C, Gausman V, Kokoy-Mondragon C, et al. Role of fluorescent in situ hybridization, cholangioscopic biopsies, and EUS-FNA in the evaluation of biliary strictures. Dig Dis Sci 2018; 63: 636–644.
    1. Genevay M, Dumonceau JM, Pepey B, et al. Fluorescence in situ hybridization as a tool to characterize genetic alterations in pancreatic adenocarcinoma. Pancreas 2010; 39: 543–544.
    1. Kato A, Naitoh I, Miyabe K, et al. An increased chromosome 7 copy number in endoscopic bile duct biopsy specimens is predictive of a poor prognosis in cholangiocarcinoma. Dig Dis Sci 2018; 63: 3376–3381.
    1. De Moura DH, Moura EHD, Bernardo WM, et al. Endoscopic retrograde cholangiopancreatography versus endoscopic ultrasound for tissue diagnosis of malignant biliary stricture: systematic review and meta-analysis. Endosc Ultrasound 2018; 7: 10–17.
    1. Moura D, De Moura E, Matuguma S, et al. EUS-FNA versus ERCP for tissue diagnosis of suspect malignant biliary strictures: a prospective comparative study. Endosc Int Open 2018; 6: E769–E777.
    1. Sadeghi A, Mohamadnejad M, Islami F, et al. Diagnostic yield of EUS-guided FNA for malignant biliary stricture: a systematic review and meta-analysis. Gastrointest Endosc 2016; 83: 290–298e291.
    1. Dumonceau JM. Sampling at ERCP for cyto- and histopathologicical examination. Gastrointest Endosc Clin N Am 2012; 22: 461–477.
    1. Ponchon T, Gagnon P, Berger F, et al. Value of endobiliary brush cytology and biopsies for the diagnosis of malignant bile duct stenosis: results of a prospective study. Gastrointest Endosc 1995; 42: 565–572.
    1. Pugliese V, Conio M, Nicolò G, et al. Endoscopic retrograde forceps biopsy and brush cytology of biliary strictures: a prospective study. Gastrointest Endosc 1995; 42: 520–526.
    1. Howell DA, Parsons WG, Jones MA, et al. Complete tissue sampling of biliary strictures at ERCP using a new device. Gastrointest Endosc 1996; 43: 498–502.
    1. Sugiyama M, Atomi Y, Wada N, et al. Endoscopic transpapillary bile duct biopsy without sphincterotomy for diagnosing biliary strictures: a prospective comparative study with bile and brush cytology. Am J Gastroenterol 1996; 91: 465–467.
    1. Jailwala J, Fogel EL, Sherman S, et al. Triple-tissue sampling at ERCP in malignant biliary obstruction. Gastrointest Endosc 2000; 51: 383–390.
    1. Kitajima Y, Ohara H, Nakazawa T, et al. Usefulness of transpapillary bile duct brushing cytology and forceps biopsy for improved diagnosis in patients with biliary strictures. J Gastroenterol Hepatol 2007; 22: 1615–1620.
    1. Weber A, Von Weyhern C, Fend F, et al. Endoscopic transpapillary brush cytology and forceps biopsy in patients with hilar cholangiocarcinoma. World J Gastroenterol 2008; 14: 1097–1101.
    1. Nanda A, Brown JM, Berger SH, et al. Triple modality testing by endoscopic retrograde cholangiopancreatography for the diagnosis of cholangiocarcinoma. Ther Adv Gastroenterol 2015; 8: 56–65.
    1. Chiang A, Theriault M, Salim M, et al. The incremental benefit of EUS for the identification of malignancy in indeterminate extrahepatic biliary strictures: a systematic review and meta-analysis. Endosc Ultrasound 2019; 8: 310–317.
    1. Jo JH, Cho CM, Jun JH, et al. Same-session endoscopic ultrasound-guided fine needle aspiration and endoscopic retrograde cholangiopancreatography-based tissue sampling in suspected malignant biliary obstruction: a multicenter experience. J Gastroenterol Hepatol 2019; 34: 799–805.
    1. Stewart CJ, Mills PR, Carter R, et al. Brush cytology in the assessment of pancreatico-biliary strictures: a review of 406 cases. J Clin Pathol 2001; 54: 449–455.
    1. De Bellis M, Fogel EL, Sherman S, et al. Influence of stricture dilation and repeat brushing on the cancer detection rate of brush cytology in the evaluation of malignant biliary obstruction. Gastrointest Endosc 2003; 58: 176–182.
    1. Ornellas LC, Santos Gda C, Nakao FS, et al. Comparison between endoscopic brush cytology performed before and after biliary stricture dilation for cancer detection. Arq Gastroenterol 2006; 43: 20–23.
    1. Mutignani M, Galasso D, Familiari P, et al. Comparison of standard and jumbo endobiliary biopsy for histological diagnosis of hilar biliary strictures: interim report of a prospective randomized trial. Gastrointest Endosc 2008; 67: AB169.
    1. Volmar KE, Vollmer RT, Routbort MJ, et al. Pancreatic and bile duct brushing cytology in 1000 cases: review of findings and comparison of preparation methods. Cancer 2006; 108: 231–238.
    1. Chen YK, Parsi MA, Binmoeller KF, et al. Single-operator cholangioscopy in patients requiring evaluation of bile duct disease or therapy of biliary stones (with videos). Gastrointest Endosc 2011; 74: 805–814.
    1. Singhi AD, Nikiforova MN, Chennat J, et al. Integrating next-generation sequencing to endoscopic retrograde cholangiopancreatography (ERCP)-obtained biliary specimens improves the detection and management of patients with malignant bile duct strictures. Gut 2020; 69: 52–61.
    1. Le N, Fillinger J, Szanyi S, et al. Analysis of microrna expression in brush cytology specimens improves the diagnosis of pancreatobiliary cancer. Pancreatology 2019; 19: 873–879.
    1. Von Seth E, Ouchterlony H, Dobra K, et al. Diagnostic performance of a stepwise cytological algorithm for biliary malignancy in primary sclerosing cholangitis. Liver Int 2019; 39: 382–388.
    1. Singh A, Gelrud A, Agarwal B. Biliary strictures: diagnostic considerations and approach. Gastroenterol Rep (Oxf) 2015; 3: 22–31.
    1. Larghi A, Tringali A, Lecca PG, et al. Management of hilar biliary strictures. Am J Gastroenterol 2008; 103: 458–473.
    1. Cillo U, Fondevila C, Donadon M, et al. Surgery for cholangiocarcinoma. Liver Int 2019; 39: 143–155.

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