High sensitivity of ROSE-supported ERCP-guided brushing on biliary strictures

Endoscopic Retrograde CholangioPancreatography (ERCP) plays a major role in biliary strictures, with brushing being a cheap and fast method to acquire cytological specimen, despite a sensitivity around 45%. Rapid On-Site Evaluation (ROSE) is widely used for Endoscopic Ultrasound-acquired cytological specimen adequacy, improving its sensitivity and specificity, nevertheless, no study evaluated its role for ERCP-guided brushing. Our aim was to assess the diagnostic yield of ERCP-guided brushing of biliary strictures when supported by ROSE. This is the database from a retrospective single-center study, including patients undergoing ERCP-guided brush cytology supported by ROSE for biliary strictures. Recorded data included patient’s clinical-radiological and ERCP features. Final diagnosis was determined after surgery, intraductal biopsy or adequate follow-up. The diagnostic yield was calculated and a subgroup analysis for factors associated with false negative or true positive result was performed. This is the first study evaluating the use of ROSE as support for ERCP-guided brushing of biliary strictures, with a sensitivity far higher than those reported for brushing alone, and at least comparable to those of more expensive and invasive techniques.