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Clin Radiol. 2014 Jan;69(1):13-7. doi: 10.1016/j.crad.2013.05.096. Epub 2013 Oct 21.

Percutaneous transhepatic cholangiobiopsy to determine the pathological cause of anastomotic stenosis after cholangiojejunostomy for malignant obstructive jaundice.

Author information

1
Department of Radiology, The First Affiliated Hospital of Zhengzhou University, PR China; Interventional Institute of Zhengzhou University, PR China; Interventional Treatment and Clinical Research Center of Henan Province, PR China.
2
Department of Radiology, The First Affiliated Hospital of Zhengzhou University, PR China; Interventional Institute of Zhengzhou University, PR China; Interventional Treatment and Clinical Research Center of Henan Province, PR China. Electronic address: hanxinwei2006@163.com.
3
Department Pathology, The First Affiliated Hospital of Zhengzhou University, PR China.
4
Department of Pathology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China.

Abstract

AIM:

To investigate the feasibility and advantages of cholangiobiopsy during percutaneous transhepatic cholangiography in the histopathological diagnosis of anastomotic stenosis after cholangiojejunostomy for malignant obstructive jaundice.

MATERIALS AND METHODS:

Using biopsy forceps, specimens were collected from the site of stenosis in patients with recurrent jaundice (n = 24) who had previously undergone cholangiojejunostomy for malignant obstructive jaundice.

RESULTS:

Stenosis occurred in all patients at the biliary-enteric anastomosis based on percutaneous transhepatic cholangiography, and was the location of the biopsy. Satisfactory specimens were obtained from 22 out of 24 patients. The sensitivity was 91.7% (22/24). Tumour tissue was obtained in 18 cases, confirming disease recurrence. Histopathological changes in four patients were diagnosed as fibroplasia and/or inflammation. These were considered cicatricial stenoses based on histopathological, imaging, and laboratory findings. The remaining two histopathology-negative patients were proven to have recurrent tumour based on imaging, laboratory, and follow-up data. No complications occurred during biopsy, including gastrointestinal haemorrhage or perforation. Either cholangial drainage and/or an inner stent was used following biopsy, which resulted in a noticeable decrease in jaundice postoperatively (p < 0.05).

CONCLUSION:

Percutaneous transhepatic cholangiobiopsy using biopsy forceps for the diagnosis of anastomotic stenosis after cholangiojejunostomy for malignant biliary obstructive jaundice is easy to perform and safe, with a high level of sensitivity. Interventional therapies, such as percutaneous transhepatic cholangial drainage and stent placement, can be performed concurrently, markedly improving the symptoms of patients with obstructive jaundice.

PMID:
24156795
DOI:
10.1016/j.crad.2013.05.096
[Indexed for MEDLINE]
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