new brush improves the diagnostic yield of indeterminate biliary stricture

Background: Brushing cytology is a useful tool in the ERCP procedure when patients receiving concomitant biliary decompression.
AIM: To determine the utility of a newly designed brush which could improve the diagnostic yield of indeterminate biliary stricture.
METHODS: Retrospective chart review was performed in all ERCP procedures with indeterminate biliary stricture brushing between January 2014 and December 2022. A standard wire-guided cytology brush was used prior to protocol implementation in July 2019, after which, a new 7.5 French wire-guided cytology brush (Infinity^®, Steris Endoscopy Co., Mentor, OH) was used for all cases.
RESULTS: Fourteen new brush cases were compared to 18 historical controls. Nine of 14 (64.3%) cases in the new brush group showed abnormal cellular findings consistent with malignancy as compared to 4 of 18 (22.2%) in the historical control group (P < 0.05). There are two true negative cases who proved to be benign strictures with the clinical course. There are three false negative patients who are two CBD and one pancreatic cancer cases after tissue proof by surgical intervention and endoscopic ultrasound guided fine needle aspiration, respectively. The overall accuracy value is 78.6%.
CONCLUSION: The use of a new brush design for brush cytology of biliary strictures shows increased diagnostic accuracy, likely due to improved cellular yield, as evidenced by an increase in number of white tissue core obtained.