Thomas Jefferson University Hospital Bethlehem, PA, United States
Award: Outstanding Research Award in the Biliary/Pancreas Category (Trainee)
Award: Presidential Poster Award
Divya M. Chalikonda, MD1, Daniel Scanlon, BA2, Ian Holmes, MD2, Muhammad Bashir, MD2, Alex Schlachterman, MD2, Anand R. Kumar, MD, MPH2, Austin Chiang, MD, MPH2, Thomas E. Kowalski, MD2, Tina Boortalary, MD2, David E. Loren, MD2 1Thomas Jefferson University Hospital, Bethlehem, PA; 2Thomas Jefferson University Hospital, Philadelphia, PA
Introduction: Fluoroscopy-guided forceps biopsy (FGFB) of indeterminate biliary strictures is one method of tissue acquisition performed at ERCP. Endoscopic techniques for FGFB have not been standardized. There are theoretical benefits to individual devices stemming from their construction, design, diameter, and maneuverability. There are no studies comparing different biopsy forceps for yield or safety. We aim to compare the safety and yield of three different biopsy forceps for FGFB at ERCP.
Methods: We conducted an observational retrospective study at a tertiary care center of patients undergoing ERCP for indeterminate biliary stricture with FGFB between 01/2018 and 05/2021. Endoscopy documentation software was queried for “stricture” and “biopsy” in patients who had ERCP. Biopsy forceps type were recorded (RadialJaw 4™ (Boston Scientific Corp, Boston, MA) jumbo, large, and pediatric corresponding to a forceps length of 2.8, 2.4 and 2.0mm, respectively, with the first two including a needle). Data points included location and length of stricture, additional biopsy modalities, cytology and pathology results, tumor markers, and clinical course. Diagnoses were considered definitive if pathology returned positive for malignancy. A benign diagnosis was determined after 6 months of follow up without concerns of cancer.
Results: 88 patients had FGFB of indeterminate biliary strictures using jumbo (n=36), large (n=9), pediatric (n=40), and a combination of pediatric and large (n=3) forceps, respectively. Definitive diagnoses were made in 30% of individuals (Table 1). There was no difference in diagnostic yield amongst the different biopsy forceps [X2(3) = 1.675 (p=0.642)]. Univariable analysis of stricture length, stricture location and presence of a mass on imaging was not associated with a definitive tissue diagnosis on biopsy. In those with negative biopsies, but in whom malignancy was identified, brush cytology most commonly yielded the diagnosis. Three patients had post-ERCP pancreatitis (all had pediatric forceps used for FGFB). No patients had biopsy induced bleeding or perforation.
Discussion: Forceps size does not affect outcome of fluoroscopy-guided forceps biopsy of biliary strictures with an overall yield of 30%. Adverse events are rare with fluoroscopic biopsy. Expansion of this dataset may offer further insights into the safety and efficacy of this procedure.
Figure: Biopsy Forceps Size and Tissue Diagnosis Yield
Divya Chalikonda indicated no relevant financial relationships.
Daniel Scanlon indicated no relevant financial relationships.
Ian Holmes indicated no relevant financial relationships.
Muhammad Bashir indicated no relevant financial relationships.
Alex Schlachterman indicated no relevant financial relationships.
Anand Kumar indicated no relevant financial relationships.
Austin Chiang indicated no relevant financial relationships.
Thomas Kowalski: Boston Scientific – Consultant. Medtronic – Consultant.
Tina Boortalary indicated no relevant financial relationships.
David Loren: Boston Scientific – Consultant. Olympus – Consultant.
Divya M. Chalikonda, MD1, Daniel Scanlon, BA2, Ian Holmes, MD2, Muhammad Bashir, MD2, Alex Schlachterman, MD2, Anand R. Kumar, MD, MPH2, Austin Chiang, MD, MPH2, Thomas E. Kowalski, MD2, Tina Boortalary, MD2, David E. Loren, MD2. P1078 - Safety and Efficacy of Fluoroscopic Forceps Biopsy of Indeterminate Biliary Strictures, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.