266 Improving the Diagnostic Yield of Single Operator Cholangioscopy (SOC)-Guided Biopsies of Indeterminate Biliary Strictures (IBS): Rapid on-Site Evaluation (ROSE) to the Rescue?

2016 ◽  
Vol 83 (5) ◽  
pp. AB134
Author(s):  
Shantel Hebert-Magee ◽  
Muhammad K. Hasan ◽  
Udayakumar Navaneethan ◽  
Ji Young Bang ◽  
Robert Hawes ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Biliary Strictures ◽  
Single Operator ◽  
Site Evaluation

Improving the diagnostic yield of single-operator cholangioscopy-guided biopsy of indeterminate biliary strictures: ROSE to the rescue? (with video)

2016 ◽  
Vol 84 (4) ◽  
pp. 681-687 ◽  
Author(s):  
Shyam Varadarajulu ◽  
Ji Young Bang ◽  
Muhammad K. Hasan ◽  
Udayakumar Navaneethan ◽  
Robert Hawes ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Biliary Strictures ◽  
Guided Biopsy ◽  
Single Operator

Diagnostic performance of different cholangioscopes in patients with biliary strictures: a systematic review

Endoscopy ◽  
2020 ◽  
Vol 52 (03) ◽  
pp. 174-185 ◽  
Author(s):  
Santi Kulpatcharapong ◽  
Rapat Pittayanon ◽  
Stephen J. Kerr ◽  
Rungsun Rerknimitr
Keyword(s):  
Diagnostic Yield ◽  
Technical Success ◽  
Biliary Strictures ◽  
Diagnostic Efficacy ◽  
Technical Success Rate ◽  
Guided Biopsy ◽  
Language Restriction ◽  
Single Operator ◽  
Malignant Biliary Stricture ◽  
Sensitivity Specificity

Abstract Background Cholangioscopy provides direct intraductual imaging, which can enhance diagnostic efficacy during endoscopic retrograde cholangiopancreatography in patients with biliary strictures. This study aimed to review the diagnostic yield of different cholangioscopes for the diagnosis of malignant biliary stricture (MBS). Methods A comprehensive literature review was performed. Full papers of prospective studies using any type of peroral cholangioscope (POC) were included without language restriction. The primary outcomes were sensitivity, specificity, and accuracy of various POCs to diagnose MBS. Results Data from 20 published articles, involving 1141 patients, were extracted. Overall sensitivities of POCs for diagnosing MBS were higher for the diagnosis made under visual impression compared with those from cholangioscopy-guided biopsy (67 % – 100 % vs. 38 % – 100 %), whereas the overall specificities were generally high and comparable (73 % – 100 % vs. 75 % – 100 %). Newer video cholangioscopes (digital single-operator POC [digital SOC], direct POC) with the exception of video dual-operator mother – baby POC (video DOC), provided better sensitivity of cholangioscopy-guided biopsy compared with fiberoptic scopes (digital SOC 80 % – 85 %, direct POC 80 % – 100 %, video DOC 38 % – 100 %, and fiberoptic SOC 49 % – 100 %, respectively). Among these video cholangioscopes, the digital SOC provided the highest technical success rate, at 100 %. Conclusions POCs enhanced the diagnostic yield for diagnosis of MBS. Compared with fiberoptic POCs that only provide good image impression, the digital SOC and direct POC were good at both image impression and cholangioscopy-guided biopsy to diagnose MBS. To ensure high technical success for MBS diagnosis, the digital SOC is a good option.

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.

Using single-operator cholangioscopy for endoscopic evaluation of indeterminate biliary strictures: results from a large multinational registry

Endoscopy ◽  
2020 ◽  
Vol 52 (07) ◽  
pp. 574-582 ◽  
Author(s):  
Majid A. Almadi ◽  
Takao Itoi ◽  
Jong Ho Moon ◽  
Mahesh K. Goenka ◽  
Dong Wan Seo ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Life Experience ◽  
Real Life ◽  
Final Diagnosis ◽  
Filling Defect ◽  
Biliary Strictures ◽  
Single Operator ◽  
Duct Stricture ◽  
Malignant Diagnosis

Abstract Background Peroral cholangioscopy (POCS) of indeterminate biliary strictures aims to achieve a diagnosis through visual examination and/or by obtaining targeted biopsies under direct visualization. In this large, prospective, multinational, real-life experience of POCS-guided evaluation of indeterminate biliary strictures, we evaluated the performance of POCS in this difficult-to-manage patient population. Methods This prospective registry enrolled patients, with indeterminate biliary strictures across 20 centers in Asia, the Middle East, and Africa. The primary end points were the ability to visualize the lesion, obtain histological sampling when intended, and an assessment of the diagnostic accuracy of POCS for malignant strictures. Patients were followed for 6 months after POCS or until a definitive malignant diagnosis was made, whichever occurred first. Results 289 patients underwent 290 POCS procedures with intent to biopsy in 182 cases. The stricture/filling defect was successfully visualized in 286/290 (98.6 %), providing a visual diagnostic impression in 253/290 (87.2 %) and obtaining adequate biopsies in 169/182 (92.9 %). Procedure-related adverse events occurred in 5/289 patients (1.7 %). POCS influenced patient management principally by elucidating filling defects or the causes of bile duct stricture or dilation. The visual impression of malignancy showed 86.7 % sensitivity, 71.2 % specificity, 65.8 % positive and 89.4 % negative predictive value, and 77.2 % overall accuracy compared with final diagnosis. Histological POCS-guided samples showed 75.3 % sensitivity, 100 % specificity, 100 % positive and 77.1 % negative predictive value, and 86.5 % overall accuracy. Conclusion In this large, real-life, prospective series, POCS was demonstrated to be an effective and safe intervention guiding the management of patients with indeterminate biliary strictures.

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