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.

A novel method of biopsy for indeterminate pancreaticobiliary strictures: tube-assisted biopsy

Endoscopy ◽  
2020 ◽  
Vol 52 (07) ◽  
pp. 589-594
Author(s):  
Sung Woo Ko ◽  
Sang Soo Lee ◽  
Hoonsub So ◽  
Jun Seong Hwang ◽  
Tae Jun Song ◽  
...  
Keyword(s):  
Success Rate ◽  
Diagnostic Yield ◽  
Rate Sensitivity ◽  
Adverse Event Rate ◽  
Technical Success ◽  
Serious Adverse Events ◽  
Technical Success Rate ◽  
Single Operator ◽  
Novel Method ◽  
Sensitivity Specificity

Abstract Background Single-operator cholangioscopy (SOC) provides an accurate diagnosis of indeterminate pancreaticobiliary strictures. However, the procedure is expensive and can be performed using only limited accessories. Therefore, we devised a novel tube-assisted biopsy (TAB) technique and evaluated its feasibility, diagnostic yield, and safety for indeterminate pancreaticobiliary strictures. Methods The medical records of patients with indeterminate pancreaticobiliary strictures who underwent TAB between September 2018 and July 2019 were reviewed. We assessed the technical success rate, adverse event rate, sensitivity, specificity, and overall accuracy of TAB in differentiating malignant from benign lesions. Results TABs were performed in 16 patients: 12 had biliary strictures; four had pancreatic strictures. The technical success rate was 93.7 % (15/16), and the sensitivity, specificity, and overall accuracy of TAB were 87.5 %, 100 %, and 93.7 %, respectively. No serious adverse events occurred either during or after the procedure in any of the patients. Conclusions TAB has an acceptable accuracy for the diagnosis of indeterminate pancreaticobiliary strictures and may represent a useful diagnostic method in patients where SOC cannot be implemented.

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

Outcomes of percutaneous transluminal biopsy of biliary lesions using a dedicated forceps system

2018 ◽  
Vol 60 (5) ◽  
pp. 602-607 ◽  
Author(s):  
Riccardo Inchingolo ◽  
Stavros Spiliopoulos ◽  
Massimiliano Nestola ◽  
Michele Nardella
Keyword(s):  
Diagnostic Accuracy ◽  
False Negative ◽  
Rate Sensitivity ◽  
Technical Success ◽  
Biliary Strictures ◽  
Tissue Samples ◽  
Technical Success Rate ◽  
Major Complications ◽  
Sensitivity Specificity ◽  
Percutaneous Transluminal

Background Distinction between benign and malignant biliary obstruction is always challenging. Purpose To evaluate outcomes of percutaneous transluminal biopsy of biliary strictures using a dedicated forceps system. Material and Methods This prospective, single-center, single-arm study, included 29 consecutive patients (17 men [56.6%]; mean age = 60 ± 9 years), who underwent 30 transluminal biopsies during percutaneous transhepatic biliary drainage (PTBD) due to obstructive jaundice, between September 2014 and January 2017, using a transluminal biliary access and biopsy forceps set. The study’s primary efficacy endpoint was technical success and the primary safety endpoint was the procedure-related major complications rate. The study’s secondary endpoints were procedure-related minor complication rate, sensitivity, specificity, and diagnostic accuracy for the characterization of malignancy. Results Tissue samples allowed histological diagnosis in 27/30 procedures (technical success rate 90.0%), as in three cases (10.0%) the sample was characterized as non-diagnostic: one case was suspicious for pancreatic cancer and two cases were cholangiocarcinoma. In one case, biopsy was successfully repeated. The diagnosis was cholangiocarcinoma in 16 cases (53.3%), colorectal metastasis in three cases (10%), pancreatic adenocarcinoma in three cases (10.0%), and inflammation in five cases (16.6%). There were two false-negative cases of inflammation proven to be cholangiocarcinoma, resulting in sensitivity of 91.67%, specificity of 100%, and accuracy of 92.59%. No major complications were noted. There were four cases of hemobilia (13%) which auto-resolved within 48 h. Conclusion Percutaneous transluminal biopsy of biliary strictures during PTBD using the specific forceps system was proven safe and resulted in high technical success and diagnostic accuracy rates.

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.

Use of endoscopic ultrasound to reduce the need for SpyGlass cholangioscopy and improve its diagnostic yield.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 169-169
Author(s):  
Nam Q. Nguyen
Keyword(s):  
Cost Saving ◽  
Endoscopic Ultrasound ◽  
Autoimmune Pancreatitis ◽  
Diagnostic Yield ◽  
Hepatic Duct ◽  
Correct Diagnosis ◽  
Biliary Tree ◽  
Biliary Strictures ◽  
Tissue Diagnosis ◽  
Guided Biopsy

169 Background: The accuracy of SpyGlass cholangioscopy (SGC) guided biopsy is only modest (60%) due to extrinsic lesion causing ductal stricture. Endoscopic ultrasound (EUS) can visualise the biliary tree and acquire tissue via fine needle aspiration (FNA). The aim is to evaluate the utility of EUS-FNA in patients who were referred for SGC for biliary strictures. Methods: The clinical impact of EUS-FNA was prospectively examined in 17 patients (10M; 56.2±1.9 yrs) who were referred for SGC to investigate difficult biliary strictures over 15 months. All patients had endoscopic retrograde cholangiography and biliary stenting with negative ductal brushing. Any mass lesion(s) or pathological node(s) found on EUS were biopsied. SGC and ductal biopsy were only performed if EUS-FNA could not provide a diagnosis. The results were compared to the surgical specimens or the positive histo-cytological findings from biopsies. Results: EUS examination was able to identify all ductal or peri-ductal abnormalities responsible for the biliary strictures, with sonographic diagnoses of cholangiocarcinoma (n=10), autoimmune pancreatitis (n=2), choledochocyst related stricture (1); pancreatic cancer (n=1), gallbladder cancer (n=1), Mirrizi’s syndrome (n=1) and colorectal metastasis (n=1). EUS-FNA was possible in 13 (76%) cases and provided tissue diagnosis in 9 (59%) patients, which can potentially avoid the need for SGC and cost saving of ~$ 48,000. SGC examination was successful in 7/8 patients, with 100% correct tissue diagnosis from Spybite biopsy (4 cholangio-carcinomas, 1 autoimmune pancreatitis, 1 biliary villous adenoma, 1 hepatoma, 1 high grade dysplastic choledochocyst). SpyScope intubation was not possible in a patient with long-standing primiary sclerosing cholangitis who had tight stricturing of the entire extra-hepatic duct. Overall, tissue diagnosis was established in 94% (16/17) patients. Conclusions: EUS able to detect 100% ductal or peri-ductal abnormalities responsible for biliary strictures referred for SGC. Together with FNA, EUS provides correct diagnosis and avoids the need for SGC in 59% of cases, resulting in significant cost saving but also improving the yield of SpyGlass guided biopsy.

scholarly journals Evaluation of cervical erosion in symptomatic women

2020 ◽  
Vol 9 (5) ◽  
pp. 2035
Author(s):  
Sindhu C. Guptha
Keyword(s):  
Pap Smear ◽  
Obstetrics And Gynecology ◽  
Prospective Clinical Study ◽  
Diagnostic Efficacy ◽  
Speculum Examination ◽  
Guided Biopsy ◽  
Menstrual Irregularities ◽  
One Year ◽  
Sensitivity Specificity ◽  
Premalignant Conditions

Background: The objective of this study was evaluation of symptomatic women with cervical erosion.Methods: Prospective clinical study done in the department of obstetrics and gynecology, VIMS, Ballari for one-year period from June 2016 to May 2017. All patients with symptoms of white discharge, post coital bleeding and menstrual irregularities were examined by per speculum examination and all those who had cervical erosion (112 Patients) were included in the study. Pap smear and colposcopy were done in all subjects. Colposcopic guided biopsy was done in women with abnormal findings on colposcopy. Histological prediction of colposcopic findings was done according to the Reid’s modified colposcopic index. The result of the biopsy was correlated with the predicted histology of the Reid’s modified colposcopic index and statistical analysis done to calculate diagnostic efficacy of colposcopy in the evaluation of symptomatic women with cervical erosion.Results: Out of the 112 patients, 5.35% (6/112) had abnormal Pap smear. All patients underwent colposcopy and colposcopic guided biopsy, 11.6% (13/112) had abnormal colposcopic findings. Histopathology confirmed CIN I in 6.25% (7/112) and CIN II in 1.78% (2/112) patients. The sensitivity, specificity, PPV, NPV and accuracy of PAP smear was found to be 22.22%, 96.11%, 33.33%, 93.39% and 90.17%. The above values for colposcopy were found to be 88.89%, 95.15%, 61.54%, 98.99% and 94.64%.Conclusions: Colposcopy should be done in all symptomatic patients with cervical erosion as it is a good diagnostic tool for premalignant conditions of the cervix and correlates well with histopathological findings.

C-arm cone-beam computed tomography with stereotactic needle guidance for percutaneous adrenal biopsy: initial experience

2016 ◽  
Vol 58 (5) ◽  
pp. 617-624 ◽  
Author(s):  
Dechao Jiao ◽  
Na Xie ◽  
Gang Wu ◽  
JianZhuang Ren ◽  
Xinwei Han
Keyword(s):  
Adrenal Gland ◽  
Success Rate ◽  
Cone Beam ◽  
Ct Guidance ◽  
Needle Guidance ◽  
Technical Success ◽  
Virtual Navigation ◽  
Technical Success Rate ◽  
Adrenal Biopsy ◽  
Sensitivity Specificity

Background Metastasis to the adrenal glands is frequent in patients with various cancers and adrenal gland biopsy is routinely performed using ultrasound or computed tomographic (CT) guidance. However, this method is technically challenging, especially in the case of small masses. Purpose To determine whether the new real-time stereotactic needle guidance technique C-arm cone-beam CT (CBCT) allows safe and accurate biopsy of adrenal gland masses, especially those in hard-to-reach anatomical locations. Material and Methods CBCT guidance was used to perform 60 stereotactic biopsy procedures of lesions that were inaccessible with ultrasound or CT guidance. The needle path was carefully planned and calculated on the CBCT virtual navigation guidance system, which acquired 3D CT-like cross-sectional images. The adrenal biopsy procedures were performed with fluoroscopic feedback. Technical success rate, sensitivity, specificity, accuracy, and complications were investigated. Results The technical success rate of adrenal biopsy under CBCT virtual navigation was 100%, with a mean total procedure time of 14.6 ± 3.6 min. Of the 60 lesions, 46 were malignant, 11 were benign, and three were non-diagnostic. The three non-diagnostic lesions proved to be malignant. Thus, the sensitivity, specificity, and accuracy were 93.8%, 100%, and 95.0%, respectively. Minor bleeding occurred in two (3.3%) cases. Conclusion CBCT guidance allows safe and accurate biopsy of adrenal gland masses and may be especially useful for hard-to-reach anatomical locations.

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