Determining benign from malignant biliary strictures can be challenging with current methods, but several Cleveland Clinic studies are shedding light on potential biomarkers and imaging techniques that are faster, more accurate and cost effective.
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Mansour A. Parsi, MD, MPH, head of the Center for Endoscopy and Pancreatobiliary Disorders in Cleveland Clinic’s Digestive Disease Institute, says current endoscopic retrograde brush cytology methods used to look at biliary strictures provide good specificity, but sensitivity is low, leading to false negative results.
“When I get a negative result, I really don’t know if it is truly negative or false negative,” he explains. “That’s a problem. For that reason, we need better bio markers or imaging techniques to find out who has malignant disease and who does not.”
Dr. Parsi led several parallel pilot studies looking at a variety of markers in differentiating malignant and benign biliary strictures:
In addition to the biomarker studies, Dr. Parsi and his team are investigating various imaging techniques, including cholangioscopy with narrow-band imaging (NBI), to improve detection of malignant biliary diseases. These techniques are expected to enhance visualization of the bile ducts, improving diagnosis of patients with indeterminate biliary strictures
Dr. Parsi’s team evaluated high-definition cholangioscopy with NBI using prototype digital cholangioscopes as an adjunct to ERCP. The technique, an improvement on the currently available cholangioscopy systems, proved helpful in evaluating various biliary disorders. The results of these studies were published in the journals Gastroenterology, Clinical Gastroenterology and Hepatology,and Gastrointestinal Endoscopy.
For more information, contact Dr. Parsi at 216.445.4880 or parsim@ccf.org.
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