Facciorusso, Antonio, Crinò, Stefano Francesco, Gkolfakis, Paraskevas, Spadaccini, Marco, Arvanitakis, Marianna, Beyna, Torsten, Bronswijk, Michiel, Dhar, Jahnvi, Ellrichmann, Mark, Gincul, Rodica, Hritz, Istvan, Kylänpää, Leena, Martinez-Moreno, Belen, Pezzullo, Martina, Rimbaş, Mihai, Samanta, Jayanta, van Wanrooij, Roy L.J., Webster, George, and Triantafyllou, Konstantinos
Main recommendations: 1 ESGE recommends the combination of endoscopic ultrasound-guided tissue acquisition (EUS-TA) and endoscopic retrograde cholangiopancreatography (ERCP)-based tissue acquisition as the preferred diagnostic approach for tissue acquisition in patients with jaundice and distal extrahepatic biliary stricture in the absence of a pancreatic mass. 2 ESGE suggests that brushing cytology should be completed along with fluoroscopy-guided biopsies, wherever technically feasible, in patients with perihilar biliary strictures. 3 ESGE suggests EUS-TA for perihilar strictures when ERCP-based modalities yield insufficient results, provided that curative resection is not feasible and/or when cross-sectional imaging has shown accessible extraluminal disease. 4 ESGE suggests using standard ERCP diagnostic modalities at index ERCP. In the case of indeterminate biliary strictures, ESGE suggests cholangioscopy-guided biopsies, in addition to standard ERCP diagnostic modalities. Additional intraductal biliary imaging modalities can be selectively used, based on clinical context, local expertise, and resource availability. [ABSTRACT FROM AUTHOR]