Malignant gastroenteric obstruction: therapeutic options.

Malignant gastric outlet obstruction is a complication of advanced pancreatic cancer, manifesting endoscopically or radiographically as a stricture of the proximal duodenum. Until recently, management consisted of surgical gastroenteric bypass with or without associated biliary bypass. Over the past decade, the endoscopic deployment of self-expanding metal stents (SEMS) emerged as a new option for restoration of enteric patency.

A new method of biliary sampling for cytopathological examination during endoscopic retrograde cholangiography.

Objectives: Biliary brushing during endoscopic retrograde cholangiography (ERC) may allow the diagnosis of cancer, but this technique is limited by a low (18-57%) sensitivity. We compared the cellular and diagnostic yields of a new sampling method (using stricture dilation and a grasping basket) with those of brushing.

Methods: Sixty consecutive patients with a suspected malignant obstruction of the common bile duct were included in a consecutive, nonrandomized order.