A novel method to obtain biopsy samples from proximal biliary strictures.

Brush cytology and forceps biopsy are the most commonly used techniques to allow a diagnosis to be reached in patients found with suspected proximal biliary malignancies during endoscopic retrograde cholangiography. However, the sensitivity of brush cytology for diagnosis of malignant biliary strictures ranges only from 30 % to 60 % [1], while in the case of the biopsy forceps it may in some cases be impossible to advance the forceps to the level of the stricture. Recently, we had experience of three cases of proximal biliary stricture in which cholangiocarcinoma was strongly suspected. In all three it proved possible to obtain sufficient biopsy samples for a diagnosis using a novel method.