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CC BY-NC-ND 4.0 · Endoscopy
DOI: 10.1055/a-2619-6803
Original article

The value of cholangioscopy-guided bite-on-bite (-on bite) biopsies in indeterminate biliary duct strictures

David M. de Jong 
1   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
,
Pieter Jan F. de Jonge
1   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
,
Pauline M. C. Stassen 
1   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
,
Petko Karagyozov 
2   Clinic of Gastroenterology, Acibadem City Clinic University Hospital Tokuda, Sofia, Bulgaria
,
Juan J. Vila 
3   Endoscopy Unit, Gastroenterology Department, Hospital Universitario de Navarra, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
,
Ignacio Fernández-Urién 
3   Endoscopy Unit, Gastroenterology Department, Hospital Universitario de Navarra, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
,
Martin W. James
4   NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, and School of Medicine, University of Nottingham, Nottingham, United Kingdom
,
Suresh V. Venkatachalapathy 
4   NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, and School of Medicine, University of Nottingham, Nottingham, United Kingdom
,
Kofi W. Oppong 
5   Department of Gastroenterology and Hepatology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
,
Andrea Anderloni 
6   Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
,
Alessandro Repici 
7   Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy
 8   Department of Biomedical Sciences, Humanitas University, Milan, Italy
,
Roberto Gabbiadini 
7   Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy
,
Deepak Joshi
 9   Institute of Liver Studies, King’s College Hospital NHS Foundation Trust, London, United Kingdom
,
Mark Ellrichmann 
10   Interdisciplinary Endoscopy, Medical Department 1, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
,
Leena Kylänpää 
11   Department of Gastrointestinal Surgery, Helsinki University Central Hospital, Helsinki, Finland
,
Marianne Udd 
11   Department of Gastrointestinal Surgery, Helsinki University Central Hospital, Helsinki, Finland
,
Frans van der Heide 
12   Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
,
Pieter Hindryckx 
13   Department of Gastroenterology and Hepatology, University Hospital of Ghent, Ghent, Belgium
,
Gareth Corbett
14   Department of Gastroenterology and Hepatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
,
Kirill Basiliya 
14   Department of Gastroenterology and Hepatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
,
Vincenzo Cennamo
15   Gastroenterology and Interventional Endoscopy Unit, Local Health Authority of Bologna, Bologna, Italy
,
Stefano Landi
15   Gastroenterology and Interventional Endoscopy Unit, Local Health Authority of Bologna, Bologna, Italy
,
Simon Phillpotts 
16   Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
,
George J. Webster
16   Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
,
Marco J. Bruno 
1   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
,
on behalf of the European Cholangioscopy Group› Author Affiliations
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Abstract

Background Digital single-operator cholangioscopy (dSOC) has improved the diagnostic accuracy of indeterminate biliary duct strictures (IBDS) through targeted intraductal biopsy sampling. However, the optimal biopsy technique remains uncertain.

Methods This international, multicenter, prospective interventional study (November 2020–August 2022) included patients with IBDS undergoing dSOC. Stricture sampling involved obtaining at least four single biopsies and at least one bite-on-bite biopsy (BBB) in all patients. Definitive diagnosis was established by pathology outcomes and 1-year clinical follow-up. The primary outcome was the accuracy of both biopsy techniques.

Results 89 patients were included, with 76 hilar strictures and 13 distal strictures. Technical success for obtaining adequate tissue samples was 82/89 (92.1 %) for single biopsies and 78/89 (87.6 %) for BBB. Malignancy was confirmed in 31/82 (37.8 %) and 29/78 (37.2 %) cases in single biopsies and BBB, respectively. Among 76 patients in whom both techniques were successful, pathology results were discordant in three cases (3.9 %), primarily due to understaging by BBB. Among 82 patients with complete follow-up, malignancy was confirmed in 51 (62.2 %). Sensitivity, specificity, and accuracy for malignancy or high grade dysplasia were 66.0 %, 100 %, and 78.8 % for single biopsies, and 63.8 %, 100 %, and 77.6 % for BBB, respectively. Sensitivity and accuracy were significantly decreased after stent placement or intraductal tissue acquisition during prior ERCP. The number of BBBs did not impact sensitivity or accuracy.

Conclusions BBB did not outperform at least four single biopsies for IBDS. Prior manipulation of IBDS, through stent placement or prior tissue acquisition, was associated with a decreased diagnostic yield.

Supplementary Material



Publication History

Received: 25 September 2024

Accepted after revision: 20 May 2025

Accepted Manuscript online:
23 May 2025

Article published online:
25 June 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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