Triple-Tissue Sampling during Endoscopic Retrograde Cholangiopancreatography Increases the Overall Diagnostic Sensitivity for

Background/Aims: There are several methods for obtaining tissue samples to diagnose malignant biliary strictures dur-ing endoscopic retrograde cholangiopancreatography (ERCP). However, each method has only limited sensitivity. This study aimed to evaluate the diagnostic accuracy of a combined triple-tissue sampling (TTS) method (on-site bile aspiration cytology, brush cytology, and forceps biopsy). Methods: We retrospectively reviewed 168 patients with suspicious malig-nant biliary strictures who underwent double-tissue sampling (DTS; n=121) or TTS (n=47) via ERCP at our institution from 2004 to 2011. Results: Among the 168 patients reviewed, 117 patients (69.6%) were eventually diagnosed with ma-lignancies. The diagnostic sensitivity for cancer was signifi-cantly higher in the TTS group than the DTS group (85.0 % vs 64.9%, respectively; p=0.022). Furthermore, the combina