Diagnostic work-up of bile duct strictures: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

2024/12/17 by Antonio Facciorusso, Stefano Francesco Crinò, Paraskevas Gkolfakis +21 · 41 citations
Medicine · #Bile duct #Colorectal Cancer Screening and Detection #Context (archaeology) #Endoscopic retrograde cholangiopancreatography #Endoscopic ultrasound #Endoscopy #Fluoroscopy #Gallbladder and Bile Duct Disorders #Guideline #Medicine #Modalities #Pancreatic and Hepatic Oncology Research #Pancreatitis #Pathology #Radiology #Surgery

paper · pdf · doi:10.1055/a-2481-7048

published in Endoscopy 57(02), 166-185 (Thieme Medical Publishers (Germany))

openalex publication_date 2024/12/17 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/05

Abstract

1: ESGE recommends the combination of endoscopic ultrasound-guided tissue acquisition (EUS-TA) and endoscopic retrograde cholangiopancreatography (ERCP)-based tissue acquisition as the preferred diagnostic approach for tissue acquisition in patients with jaundice and distal extrahepatic biliary stricture in the absence of a pancreatic mass. 2: ESGE suggests that brushing cytology should be completed along with fluoroscopy-guided biopsies, wherever technically feasible, in patients with perihilar biliary strictures. 3: ESGE suggests EUS-TA for perihilar strictures when ERCP-based modalities yield insufficient results, provided that curative resection is not feasible and/or when cross-sectional imaging has shown accessible extraluminal disease. 4: ESGE suggests using standard ERCP diagnostic modalities at index ERCP. In the case of indeterminate biliary strictures, ESGE suggests cholangioscopy-guided biopsies, in addition to standard ERCP diagnostic modalities. Additional intraductal biliary imaging modalities can be selectively used, based on clinical context, local expertise, and resource availability.

Citations

• Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis

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• Endoscopic ultrasound-directed transenteric ERCP in patients with benign and malignant diseases and inaccessible biliary system. [europepmc]
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