P.14.12 DOES PERORAL CHOLANGIOSCOPY (POC) USING SPYGLASS SYSTEM REALLY IMPROVE THE DIAGNOSTIC YIELD IN INDETERMINATE BILIARY STRICTURES MANAGEMENT? CAN WE DO WITHOUT IT?

Abstract Background Although endoscopic retrograde cholangiopancreatography (ERCP) is a first-line diagnostic modality for suspected malignant biliary stricture (MBS), the diagnostic yield of ERCP-based tissue sampling is insufficient. Peroral cholangioscopy-guided forceps biopsy (POC-FB) and endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) are evolving as reliable diagnostic procedures for inconclusive MBS. This study aimed to evaluate the usefulness of a diagnostic approach using POC-FB or EUS-FNAB according to the stricture location in patients with suspected MBS. Methods Consecutive patients diagnosed with suspected MBS with obstructive jaundice and/or cholangitis were enrolled prospectively. ERCP with transpapillary forceps biopsy (TPB) was performed initially. When malignancy was not confirmed by TPB, POC-FB using a SpyGlass direct visualization system or direct POC using an ultraslim endoscope was performed for proximal strictures, and EUS-FNAB was performed for distal strictures as a follow-up biopsy. Results Among a total of 181 patients, initial TPB showed malignancy in 122 patients, and the diagnostic accuracy of initial TPB was 71.8 % (95 % confidence interval [CI] 65.3 % – 78.4 %]. Of the 59 patients in whom TPB was negative for malignancy, 32 had proximal biliary strictures and underwent successful POC. The remaining 27 patients had distal strictures and underwent successful EUS-FNAB. The accuracy of malignancy detection using POC-FB for proximal biliary strictures and EUS-FNAB for distal biliary strictures was 93.6 % (95 %CI 84.9 %−100 %) and 96.3 % (95 %CI 89.2 %−100 %), respectively. The overall diagnostic accuracy for the combination of TPB with either POC-FB for proximal strictures and EUS-FNAB for distal strictures was 98.3 % (95 %CI 95.9 %−100 %) and 98.4 % (95 %CI 95.3 %−100 %), respectively. Conclusions An approach using POC-FB or EUS-FNAB according to the stricture location may be useful in the diagnosis of suspected MBS.

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Mo1469 PerOral Cholangioscopy Has a High Diagnostic Yield and Frequently Alters Patient Management in Indeterminate Biliary Strictures, Primary Sclerosing Cholangitis and Large Bile Duct Stones

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2011.03.767 ◽

2011 ◽

Vol 73 (4) ◽

pp. AB355-AB356

Author(s):

Milan S. Bassan ◽

Suhirdan Vivekanandarajah ◽

Paul D. Edwards

Keyword(s):

Bile Duct ◽

Primary Sclerosing Cholangitis ◽

Sclerosing Cholangitis ◽

Patient Management ◽

Diagnostic Yield ◽

Bile Duct Stones ◽

Biliary Strictures ◽

Peroral Cholangioscopy ◽

High Diagnostic Yield ◽

Large Bile Duct

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Su1588 Performance Characteristics and Lack of Factors Affecting Diagnostic Yield of Single Operator PerOral Cholangioscopy for Indeterminate Biliary Strictures

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2015.03.1485 ◽

2015 ◽

Vol 81 (5) ◽

pp. AB341

Author(s):

Aaron J. Small ◽

Gregory Lutzak ◽

Seng-Ian Gan ◽

Shayan Irani ◽

Michael Gluck ◽

...

Keyword(s):

Diagnostic Yield ◽

Performance Characteristics ◽

Biliary Strictures ◽

Factors Affecting ◽

Peroral Cholangioscopy ◽

Single Operator

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Advances of Peroral Cholangioscopy and EUS for Indeterminate Biliary Lesions

The Korean Journal of Pancreas and Biliary Tract ◽

10.15279/kpba.2020.25.1.29 ◽

2020 ◽

Vol 25 (1) ◽

pp. 29-33

Author(s):

Yun Nah Lee

Keyword(s):

Diagnostic Yield ◽

Diagnostic Procedures ◽

Needle Aspiration ◽

Biliary Strictures ◽

Diagnostic Modality ◽

Visualization System ◽

Technical Performance ◽

Peroral Cholangioscopy ◽

Tailored Approach ◽

Spyglass Direct Visualization System

Traditionally, biliary lesions have been considered to be indeterminate when a diagnosis cannot be made after basic laboratory work-up, abdominal imaging and endoscopic retrograde cholangiopancreatography (ERCP) with biliary sampling. Although ERCP is a first-line diagnostic modality for indeterminate biliary lesions, the diagnostic yield of ERCP-based tissue sampling is insufficient. In a recent, peroral cholangioscopy (POC)- guided forceps biopsy and endoscopic ultrasound-guided fine-needle aspiration (EUSFNA) are evolving as reliable diagnostic procedures for indeterminate biliary lesions. In previous studies, EUS-FNA was sensitive and highly specific for diagnosing malignancy in biliary strictures. However, EUS-FNA has several limitations as a routine clinical procedure for all biliary strictures. Newly developed POC systems, such as the SpyGlass direct visualization system and direct POC using an ultra-slim endoscope, have led to excessive improvements in technical performance and diagnostic yields for biliary strictures. However, the performance of POC-guided target biopsy for distal bile duct strictures is technically difficult, and this approach has a limited ability to diagnose biliary strictures caused by non-intraductal, extrinsic compressed malignancies, such as a pancreatic cancer. Therefore, a tailored approach using optimized endoscopic modalities that are specific to the characteristics of a given biliary stricture is needed to achieve a high diagnostic yield for indeterminate biliary lesions.

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Sa1506 PerOral Cholangioscopy for the Evaluation of Indeterminate Biliary Strictures: A Single Center Experience

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2011.03.240 ◽

2011 ◽

Vol 73 (4) ◽

pp. AB191

Author(s):

Pari M. Shah ◽

Supriya Rao ◽

Gregory G. Ginsberg ◽

Nuzhat A. Ahmad ◽

David L. Jaffe ◽

...

Keyword(s):

Single Center ◽

Biliary Strictures ◽

Peroral Cholangioscopy ◽

Single Center Experience

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

Endoscopy ◽

10.1055/a-1061-7067 ◽

2019 ◽

Vol 52 (02) ◽

pp. 107-114 ◽

Cited By ~ 7

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.

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