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

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

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2015.04.030 ◽

2015 ◽

Vol 82 (4) ◽

pp. 608-614.e2 ◽

Cited By ~ 110

Author(s):

Udayakumar Navaneethan ◽

Muhammad K. Hasan ◽

Vennisvasanth Lourdusamy ◽

Basile Njei ◽

Shyam Varadarajulu ◽

...

Keyword(s):

Systematic Review ◽

Biliary Strictures ◽

Single Operator ◽

Targeted Biopsies

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

Digestion ◽

10.1159/000513713 ◽

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.

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THE CURRENT DIAGNOSTIC ACCURACY AND INTER-OBSERVER AGREEMENT OF VISUAL IMPRESSION WITH DIGITAL SINGLE-OPERATOR CHOLANGIOSCOPY FOR THE DIAGNOSIS OF INDETERMINATE BILIARY STRICTURES

10.1055/s-0040-1704095 ◽

2020 ◽

Author(s):

P Stassen ◽

G Goodchild ◽

PJ de Jonge ◽

N Erler ◽

JW Poley ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Observer Agreement ◽

Biliary Strictures ◽

Visual Impression ◽

Single Operator

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Aspiration fluid cytology during single operator cholangioscopy with targeted biopsy to improves the diagnostic yield in indeterminate biliary strictures

Diagnostic Cytopathology ◽

10.1002/dc.24741 ◽

2021 ◽

Author(s):

Khushboo Munot ◽

Isaac Raijman ◽

Vinshi Khan ◽

Cassandra Gandle ◽

Marwah Shahid ◽

...

Keyword(s):

Diagnostic Yield ◽

Targeted Biopsy ◽

Biliary Strictures ◽

Single Operator ◽

Fluid Cytology

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Spyglass single-operator peroral cholangioscopy seems promising in the evaluation of primary sclerosing cholangitis-related biliary strictures

Scandinavian Journal of Gastroenterology ◽

10.3109/00365521.2014.940376 ◽

2014 ◽

Vol 49 (11) ◽

pp. 1385-1390 ◽

Cited By ~ 19

Author(s):

Antti Siiki ◽

Irina Rinta-Kiikka ◽

Tarmo Koivisto ◽

Kaija Vasama ◽

Juhani Sand ◽

...

Keyword(s):

Primary Sclerosing Cholangitis ◽

Sclerosing Cholangitis ◽

Biliary Strictures ◽

Peroral Cholangioscopy ◽

Single Operator

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

Endoscopy ◽

10.1055/a-1135-8980 ◽

2020 ◽

Vol 52 (07) ◽

pp. 574-582 ◽

Cited By ~ 3

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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