Parasites and Biliary stones

Endoscopic retrograde cholangiopancreatography ١٢١
Endoscopic biopsy:
Biopsies can be taken in the standard endoscopic manner. However,
biopsies can also be taken from both the biliary and pancreatic ducts at
ERCP under fluoroscopic guidance or under direct vision using the
"mother and baby" choledochoscope. Although forceps, particularly
pediatric forceps, can be advanced directly through the papilla, a
sphincterotomy is usually necessary before passing the biopsy forceps
into the biliary or pancreatic duct (figure 24) (Lee and Leung, 1998).
Any attempt to obtain deeper cytological specimens is desirable with
ductal pathology, as tumors can be extrinsic, submucosal, or associated
with a significant desmoplastic reaction. There is higher sensitivity for
cancer detection for forceps biopsy than brush cytology (81% versus
48%). Taking more biopsies may also increase the diagnostic yield, and
probably three or four biopsies should be taken (Kubota et al., 1993).
Figure (24): Radiographic image of an open biopsy forceps within the common bile
duct (Byrne and Jowell, 2003)