ASGE Annual Postgraduate Course: Leveraging New Advances to Improve Patient Outcomes (Live and Virtual) | May 2024-Proving cancer in indeterminate biliary strictures

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Dr. Uzma D. Siddiqui discusses the challenges of diagnosing cancer in Indeterminate Biliary Strictures (IDBS) due to the complexity of biliary lesions and strictures. The document highlights the importance of using Endoscopic Ultrasound (EUS) and Endoscopic Retrograde Cholangiopancreatography (ERCP) for evaluation and sampling. EUS is recommended for assessing small masses and potential metastases. ERCP with Brush Cytology (BC) and Fluoroscopic Guided Biopsy (FGB) can aid in diagnosing malignancies. Moreover, ERCP with Cholangioscopy allows for direct visualization inside the bile duct, although there are associated risks like bacteremia. Various classification systems and visual criteria are utilized to detect malignancies accurately. Surgical interventions may be necessary in cases where cancer is confirmed. Techniques such as Fluorescence In Situ Hybridization (FISH) and Next Generation Sequencing are recommended to improve diagnostic accuracy. The integration of AI with cholangioscopy shows promise in enhancing detection rates. Recommendations from various guidelines suggest a multi-disciplinary approach for managing IDBS, emphasizing the importance of thorough evaluation and sampling techniques to expedite diagnosis and treatment.

Asset Subtitle

Uzma D. Siddiqui, MD, MASGE

Keywords

Diagnosing cancer

Indeterminate Biliary Strictures

Endoscopic Ultrasound

Endoscopic Retrograde Cholangiopancreatography

Brush Cytology

Fluoroscopic Guided Biopsy

Cholangioscopy

Fluorescence In Situ Hybridization

Next Generation Sequencing

Artificial Intelligence