American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the diagnosis of malignancy in biliary strictures of undetermined etiology: summary and recommendations

Larissa L Fujii-Lau; Nirav C Thosani; Mohammad Al-Haddad; Jared Acoba; Curtis J Wray; Rodrick Zvavanjanja; Stuart K Amateau; James L Buxbaum; Audrey H Calderwood; Jean M Chalhoub; Nayantara Coelho-Prabhu; Madhav Desai; Sherif E Elhanafi; Douglas S Fishman; Nauzer Forbes; Laith H Jamil; Terry L Jue; Divyanshoo R Kohli; Richard S Kwon; Joanna K Law; Jeffrey K Lee; Jorge D Machicado; Neil B Marya; Swati Pawa; Wenly Ruan; Mandeep S Sawhney; Sunil G Sheth; Andrew Storm; Nikhil R Thiruvengadam; Bashar J Qumseya; (ASGE Standards of Practice Committee Chair, 2020-2023)

doi:10.1016/j.gie.2023.06.005

American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the diagnosis of malignancy in biliary strictures of undetermined etiology: summary and recommendations

Gastrointest Endosc. 2023 Nov;98(5):685-693. doi: 10.1016/j.gie.2023.06.005. Epub 2023 Jun 10.

Authors

Larissa L Fujii-Lau¹, Nirav C Thosani², Mohammad Al-Haddad³, Jared Acoba⁴, Curtis J Wray⁵, Rodrick Zvavanjanja⁶, Stuart K Amateau⁷, James L Buxbaum⁸, Audrey H Calderwood⁹, Jean M Chalhoub¹⁰, Nayantara Coelho-Prabhu¹¹, Madhav Desai¹², Sherif E Elhanafi¹³, Douglas S Fishman¹⁴, Nauzer Forbes¹⁵, Laith H Jamil¹⁶, Terry L Jue¹⁷, Divyanshoo R Kohli¹⁸, Richard S Kwon¹⁹, Joanna K Law²⁰, Jeffrey K Lee²¹, Jorge D Machicado¹⁹, Neil B Marya²², Swati Pawa²³, Wenly Ruan¹⁴, Mandeep S Sawhney²⁴, Sunil G Sheth²⁴, Andrew Storm¹¹, Nikhil R Thiruvengadam²⁵, Bashar J Qumseya²⁶; (ASGE Standards of Practice Committee Chair, 2020-2023)

Affiliations

¹ Department of Gastroenterology, University of Hawaii, Honolulu, Hawaii, USA.
² Center for Interventional Gastroenterology.
³ Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
⁴ Department of Hematology and Medical Oncology, University of Hawaii Cancer Center, Honolulu, Hawaii, USA.
⁵ Department of Surgery.
⁶ Department of Diagnostic and Interventional Imaging, UTHealth, McGovern Medical School, Houston, Texas, USA.
⁷ Division of Gastroenterology Hepatology and Nutrition, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
⁸ Division of Gastrointestinal and Liver Diseases, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.
⁹ Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA.
¹⁰ Department of Gastroenterology and Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York, USA.
¹¹ Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
¹² Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
¹³ Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
¹⁴ Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
¹⁵ Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
¹⁶ Section of Gastroenterology and Hepatology, Beaumont Health, Royal Oak, and Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.
¹⁷ Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA.
¹⁸ Pancreas and Liver Clinic, Providence Sacred Heart Medical Center, Spokane, Washington, USA.
¹⁹ Division of Gastroenterology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.
²⁰ Department of Gastroenterology and Hepatology, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA.
²¹ Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA.
²² Division of Gastroenterology and Hepatology, UMass Chan Medical School, Worcester, Massachusetts, USA.
²³ Department of Gastroenterology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
²⁴ Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
²⁵ Division of Gastroenterology and Hepatology, Loma Linda University, Loma Linda, California, USA.
²⁶ Department of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA.

PMID: 37307900
DOI: 10.1016/j.gie.2023.06.005

Abstract

This clinical practice guideline from the American Society for Gastrointestinal Endoscopy provides an evidence-based approach for the diagnosis of malignancy in patients with biliary strictures of undetermined etiology. This document was developed using the Grading of Recommendations Assessment, Development and Evaluation framework and addresses the role of fluoroscopic-guided biopsy sampling, brush cytology, cholangioscopy, and EUS in the diagnosis of malignancy in patients with biliary strictures. In the endoscopic workup of these patients, we suggest the use of fluoroscopic-guided biopsy sampling in addition to brush cytology over brush cytology alone, especially for hilar strictures. We suggest the use of cholangioscopic and EUS-guided biopsy sampling especially for patients who undergo nondiagnostic sampling, cholangioscopic biopsy sampling for nondistal strictures and EUS-guided biopsy sampling distal strictures or those with suspected spread to surrounding lymph nodes and other structures.

Publication types

Practice Guideline