scholarly journals Single-operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate biliary strictures: a systematic review

2015 ◽  
Vol 82 (4) ◽  
pp. 608-614.e2 ◽  
Author(s):  
Udayakumar Navaneethan ◽  
Muhammad K. Hasan ◽  
Vennisvasanth Lourdusamy ◽  
Basile Njei ◽  
Shyam Varadarajulu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Biliary Strictures ◽  
Single Operator ◽  
Targeted Biopsies

scholarly journals Limited diagnostic accuracy and clinical impact of single-operator peroral cholangioscopy for indeterminate biliary strictures

Endoscopy ◽  
2019 ◽  
Vol 52 (02) ◽  
pp. 107-114 ◽  
Author(s):  
Adriaan B. de Vries ◽  
Frans van der Heide ◽  
Rinze W. F. ter Steege ◽  
Jan Jacob Koornstra ◽  
Karel T. Buddingh ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Patient Management ◽  
Clinical Impact ◽  
Biliary Strictures ◽  
Brush Cytology ◽  
Peroral Cholangioscopy ◽  
Single Operator ◽  
Sensitivity Specificity ◽  
Targeted Biopsies

Abstract Background Single-operator peroral cholangioscopy (sPOCS) is considered a valuable diagnostic modality for indeterminate biliary strictures. Nevertheless, studies show large variation in its characteristics and measures of diagnostic accuracy. Our aim was to estimate the diagnostic accuracy of sPOCS visual assessment and targeted biopsies for indeterminate biliary strictures. Additional aims were: estimation of the clinical impact of sPOCS and comparison of diagnostic accuracy with brush cytology. Methods A retrospective single-center study of adult patients who underwent sPOCS for indeterminate biliary strictures was performed. Diagnostic accuracy was defined as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The clinical impact of sPOCS was assessed by review of medical records, and classified according to its influence on patient management. Results 80 patients were included, with 40 % having primary sclerosing cholangitis (PSC). Prior ERCP was performed in 88 %, with removal of a biliary stent prior to sPOCS in 55 %. The sensitivity, specificity, PPV, and NPV for sPOCS visual impression and targeted biopsies were 64 %, 62 %, 41 %, and 84 %, and 15 %, 65 %, 75 %, and 69 %, respectively. The clinical impact of sPOCS was limited; outcome changed management in 17 % of patients. Sequential brush cytology sensitivity, specificity, PPV, and NPV were 47 %, 95 %, 80 %, and 83 %. Conclusions The diagnostic accuracy of sPOCS for indeterminate biliary strictures was found to be inferior to brush cytology, with a low impact on patient management. These findings are obtained from a select patient population with a high prevalence of PSC and plastic stents in situ prior to sPOCS.

Efficacy of digital single-operator cholangioscopy in the visual interpretation of indeterminate biliary strictures: a systematic review and meta-analysis

2020 ◽  
Vol 34 (8) ◽  
pp. 3321-3329 ◽  
Author(s):  
Pedro Victor Aniz Gomes de Oliveira ◽  
Diogo Turiani Hourneaux de Moura ◽  
Igor Braga Ribeiro ◽  
Ahmad Najdat Bazarbashi ◽  
Tomazo Antonio Prince Franzini ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Visual Interpretation ◽  
Biliary Strictures ◽  
Single Operator

scholarly journals Diagnostic Accuracy and Therapeutic Efficacy of Digital Single-Operator Cholangioscopy for Biliary Lesions and Stenosis

Digestion ◽  
2021 ◽  
pp. 1-7
Author(s):  
Kilian Weigand ◽  
Merlin Küchle ◽  
Ina Zuber-Jerger ◽  
Martina Müller ◽  
Arne Kandulski
Keyword(s):  
Bile Duct ◽  
Diagnostic Accuracy ◽  
High Volume ◽  
Laser Lithotripsy ◽  
Biliary Strictures ◽  
Predictive Values ◽  
High Diagnostic Accuracy ◽  
Tertiary Center ◽  
Single Operator ◽  
Targeted Biopsies

Background/Aims: Digital single-operator cholangioscopy (dSOC) has revolutionized bile duct visualization. Interventions like electrohydraulic or laser lithotripsy, inspection of suspicious areas, and targeted biopsies have become possible quick and easy. One main indication for dSOC remains the evaluation of indeterminate biliary strictures. Objective and Methods: We analyzed 180 consecutive dSOCs procedures performed in a high-volume tertiary center to evaluate sensitivity, specificity as well as positive and negative predictive values (PPV and NPV) for indeterminate strictures. Furthermore, technical success and complications were analyzed. Results: In 92–97%, the region of interest was reached and successfully visualized. In 83–100%, targeted biopsies were obtained from the suspicious area. Only the distal bile duct was less successful with only 84 and 62%, respectively. In general, dSOC procedures were safe. Cholangitis was the main complication. Regarding the diagnostic accuracy of dSOC of indeterminate biliary strictures, we found a sensitivity of 0.87 and specificity of 0.88, over all. Within the whole cohort, the investigators’ assessment directly after dSOC had a PPV of 0.63 and a NPV of 0.97. In patients with biliary lesions or stenosis suspicious for malignancy, the dSOC-based visual diagnosis revealed a very high diagnostic accuracy with sensitivity and specificity of 1.0 (95% CI 0.86–1.0) and 0.76 (95% CI 0.56–0.9) with a PPV of 0.77 (95% CI 0.59–0.9) and a high NPV of 1.0 (95% CI 0.85–1.0). Conclusions: Our study demonstrates that dSOC has a high diagnostic accuracy as well as a favorable safety profile. Therefore, dSOC should be discussed as standard of care during endoscopic retrograde cholangiography for indeterminate biliary lesions.

Tu1442 Digital Single-Operator Cholangioscopy and Indeterminate Biliary Strictures: Improved Visual Optics Enhance the Yield of Targeted Biopsies

2017 ◽  
Vol 85 (5) ◽  
pp. AB629
Author(s):  
Mahmoud Omar ◽  
Dean Ehrlich ◽  
Stephen Kim ◽  
Saleh M. Saleh ◽  
Hassan Zaghla ◽  
...  
Keyword(s):  
Biliary Strictures ◽  
Visual Optics ◽  
Single Operator ◽  
Targeted Biopsies

scholarly journals ENDOSCOPIC TREATMENT OF POST-LIVER TRANSPLANTATION ANASTOMOTIC BILIARY STRICTURE: systematic review andmeta-analysis

2014 ◽  
Vol 51 (3) ◽  
pp. 240-249 ◽  
Author(s):  
Lucas Souto NACIF ◽  
Wanderley Marques BERNARDO ◽  
Luca BERNARDO ◽  
Wellington ANDRAUS ◽  
Lucas TORRES ◽  
...  
Keyword(s):  
Systematic Review ◽  
Liver Transplantation ◽  
Endoscopic Treatment ◽  
Clinical Success ◽  
Controlled Trial ◽  
Balloon Dilation ◽  
Plastic Stents ◽  
Metal Stents ◽  
Complication Rates ◽  
Biliary Strictures

Context Biliary strictures after liver transplantation are recognized as its Achilles’ heel. The strictures are classified in anastomotic and ischemic or non-anastomotic biliary strictures, and they figure among the most common complications after liver transplantation. There are some treatment options including balloon dilation, the placement of multiple plastic stents and the placement of self-expandable metal stents and all of them seem to have good results. Objectives The aim of this study was to systematically review the literature concerning the results of the endoscopic treatment of anastomotic biliary strictures after liver transplantation. Methods A systematic review of the literature was performed on the management of anastomotic biliary strictures post- orthotopic liver transplantation. The Medline-PubMed, EMBASE, Scielo-LILACS, and Cochrane Databases were electronically searched from January 1966 to April 2013. Results No well-designed randomized controlled trial was found. Most studies were retrospective or prospective comparisons in design. One study (86 patients) compared the endoscopic and the percutaneous accesses. The sustained clinical success rates were similar but the treatment duration was longer in the percutaneous group access. Two studies (56 patients) compared balloon dilation with balloon dilation and multiple plastic stents. There were no differences concerning sustained clinical success and complication rates. Conclusions Balloon dilation is as effective as balloon dilation plus multiple plastic stenting for the resolution of the anastomotic biliary strictures. Well-designed randomized trials are still needed to compare balloon dilation versus multiple plastic stenting versus metallic stenting.

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