Endoscopy in Gastrointestinal Oncology - Slide 12 - J. Baillie - Distinguishing benign from malignant biliary strictures

John Baillie, MB ChB, FRCP, FACG, FASGE Wake Forest University Health Sciences Winston-Salem, North Carolina

VICTORIA INFIRMARY, GLASGOW, SCOTLAND

MIDDLESEX HOSPITAL, LONDON TOWER BRIDGE, LONDON

DUKE UNIVERSITY MEDICAL CENTER

WAKE FOREST UNIVERSITY HEALTH SCIENCES, WINSTON-SALEM, NORTH CAROLINA, USA

Managing Biliary Strictures ,[object Object],[object Object]

Managing Biliary Strictures ,[object Object],[object Object],[object Object]

Managing Biliary Strictures ,[object Object],[object Object],[object Object],[object Object]

33 year old man with longstanding ulcerative colitis

Primary Sclerosing Cholangitis

40 yr old woman with fever and malaise after lap cholecystectomy

Ischemic injury to R main hepatic duct from misplaced clip

75 year old man with progressive painless jaundice and itching

Mass at the biliary confluence: cholangiocarcinoma (Klatskin tumor)

CLASSIFICATION OF KLATSKIN TUMORS

Managing Biliary Strictures ,[object Object]

Biliary Strictures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Biliary Strictures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

mass mass EUS in malignancy EUS diagnosis and Whipple resection of 15mm pancreatic cancer missed by CT

Managing Biliary Strictures ,[object Object],[object Object],[object Object],[object Object],[object Object]

Managing Biliary Strictures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Managing Biliary Strictures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Managing Biliary Strictures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Managing Biliary Strictures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Brush cytology: yield about 30%

Needle core/biopsy: yield about 50-60%

F.I.S.H. Fluorescent In Situ Hybridization

Markers in Pancreatic Cancer ,[object Object],[object Object],[object Object],Courtesy of Dr Michelle Anderson, MD

Diagnosis of Malignancy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Diagnosis of Malignancy in Biliary Strictures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Endoscopy in Gastrointestinal Oncology - Slide 12 - J. Baillie - Distinguishing benign from malignant biliary strictures

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