Proksimal biliyer darlıklı hastalarda yeni bir endoskopik biyopsi alma yöntemi

Giriş ve Amaç: Endoskopik retrograd kolanjiografi sırasında malignite kuşkusu oluşturan proksimal biliyer darlıklarda tanıya ulaşmak için en sık olarak endoskopik biyopsi alma yöntemi kullanılır. Ancak bazı olgularda biyopsi forsepsini darlık seviyesine ilerletmek imkansız olabilmektedir. Bu çalışmada amaç, proksimal biliyer darlıklı olgularda yeni bir endoskopik biyopsi yönteminin etkinliğini prospektif olarak değerlendirmektir. Gereç ve Yöntem: Kasım 2013-Haziran 2015 tarihleri arasında, Ege Üniversitesi Tıp Fakültesi endoskopik retrograd kolanjiopankreatografi ünitesinde proksimal biliyer darlık nedeniyle endoskopik biyopsi alma işleminin uygulandığı hastalar çalışmaya dahil edildi. Endoskopik biyopsi işlemi stent itici içinden ilerletilen bir biyopsi forsepsi ile yapıldı. Hastaların tüm tıbbi kayıtları irdelendi. Bulgular: Toplam 9 hasta [6 erkek, 3 kadın, yaş ortalaması: 65.2 (58-73) yıl] çalışmaya dahil edildi. Hastaların nihai tanıları kolanjiokarsinom (Klatskin tümörü) (n=6), safra kesesi karsinomu (n=2) ve post-operatif benign biliyer darlık (n=1) olarak saptandı. Klatskin tümörü ve safra kesesi karsinomu tanılı hastaların tamamında endoskopik biyopsi spesmenlerinin histopatolojik inceleme sonucu adenokarsinom olarak rapor edildi. Sonuç: Proksimal biliyer darlıklı olgularda stent itici içinden ilerletilen biyopsi forsepsi ile uygulanan endoskopik biyopsi metodu histopatolojik tanıya ulaşmada etkilidir.

A new endoscopic biopsy method for patients with proximal biliary strictures

Background and Aims: Endoscopic biopsy is the most commonly used technique to reach a diagnosis in patients with suspected proximal biliary malignancies during endoscopic retrograde cholangiography. However, it may be impossible to advance the standard biopsy forceps to the stricture level in some cases. The aim of this study was to prospectively evaluate the effectivity of a new endoscopic biopsy method for patients with proximal biliary strictures. Materials and Methods: Patients with proximal biliary strictures who underwent an endoscopic biopsy procedure in endoscopic retrograde cholangiopancreatography unit of Ege University Medical School between November 2013 and June 2015 were enrolled in the study. Endoscopic biopsy procedure was performed with a biopsy forceps which was advancing through a stent pusher. All of the medical records of the patients were reviewed. Results: A total of 9 patients [6 male, 3 female; mean age: 65.2 (58- 73) years] were enrolled in the study. Final diagnosis was cholangiocarcinoma (Klatskin tumour), gall bladder carcinoma, and post-operative benign biliary stricture in 6, 2, and 1 patients, respectively. Histopathological examinations of the endoscopic biopsy specimens revealed adenocarcinoma in all patients with Klatskin tumour and gall bladder carcinoma. Conclusions: The presented endoscopic biopsy method using biopsy forceps through the stent pusher is effective to achieve a histopathological diagnosis in patients with proximal biliary strictures.

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