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.

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.

scholarly journals CHOLANGIOSCOPY IN BILE DUCT DISEASE: a case series

2014 ◽  
Vol 51 (3) ◽  
pp. 250-254 ◽  
Author(s):  
Eduardo Guimarães Hourneaux de MOURA ◽  
Tomazo FRANZINI ◽  
Renata Nobre MOURA ◽  
Fred Olavo Aragão Andrade CARNEIRO ◽  
Everson Luiz de Almeida ARTIFON ◽  
...  
Keyword(s):  
Bile Duct ◽  
Balloon Dilation ◽  
Case Series ◽  
Therapeutic Endoscopy ◽  
Duodenal Perforation ◽  
Biliary Strictures ◽  
Electrohydraulic Lithotripsy ◽  
Single Operator ◽  
Large Bile Duct ◽  
Bile Duct Disease

Context Direct endoscopic visualization of biliopancreatic duct is certainly one of the greatest advances of therapeutic endoscopy. The use of a single-operator cholangioscopy platform (SpyGlass) is a promising technique in the evaluation of diseases such as indeterminate biliary stricture and giant choledocholitiasis. This is the first Brazilian case series using this technology. Methods We report a case series of 20 patients in whom SpyGlass was used with diagnostic and therapeutic intention. Results Most patients were female (60%) and the median age was 48 years (ranging from 14 to 94). Choledocholitiasis was the most common indication (12/20), and electrohydraulic lithotripsy was applied in eight (66%). Electrohydraulic lithotripsy was successful in seven (87.5%) patients. Partial stone fragmentation occurred in one patient with large stone causing stone-choledochal disproportion, which was conducted with biliary plastic stent placement and a second scheduled endoscopic approach in 3 months. In cases of undefined etiology of biliary strictures, it was possible to exclude malignancy due to direct visualization (7/8) or biopsy (1/8). One complication occurred (duodenal perforation) after papillary balloon dilation. Conclusion The use of SpyGlass demonstrated the benefits, especially in cases of large bile duct stones and indeterminate biliary strictures. Other potencial improvements such as reduction on radiation exposure should be confirmed in prospective studies.

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

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

Diagnostic Accuracy and Clinical Utility of Endoscopic Bile Duct Brushing in the Evaluation of Biliary Strictures

1999 ◽  
Vol 123 (8) ◽  
pp. 712-715 ◽  
Author(s):  
Vincent Trent ◽  
Kamal K. Khurana ◽  
Latha R. Pisharodi
Keyword(s):  
Bile Duct ◽  
Diagnostic Accuracy ◽  
False Positive ◽  
Clinical Utility ◽  
False Positive Rate ◽  
False Negative ◽  
False Negative Rate ◽  
Atypical Hyperplasia ◽  
Biliary Strictures

Abstract Pathologic evidence of malignancy in biliary strictures is useful in the preoperative setting because it helps define therapeutic planning and prognosis. The purpose of this study was to assess the diagnostic accuracy and clinical utility of endoscopic bile duct brushings in the evaluation of bile duct strictures. We retrospectively evaluated 34 endoscopic biliary brushings derived from 31 patients with bile duct strictures. Relevant clinical and follow-up data were collected. Histologic specimens were reviewed in patients undergoing subsequent biopsies. Patients included 18 men and 13 women with an age range of 25 to 79 years (mean, 52 years). All patients had histologic and/or clinical follow-up. Cytologic diagnosis included cholangiocarcinoma (14.7%), suspicious for cholangiocarcinoma (5.9%), atypical hyperplasia (17.6%), and negative for malignancy (61.7%). All positive diagnoses were confirmed by histologic testing (false-positive rate, 0%). The cases that were suspicious for cholangiocarcinoma and the 5 atypical hyperplasia cases were also subsequently diagnosed as cholangiocarcinoma by biopsy. One atypical case was diagnosed as pancreatic carcinoma. All 21 negative cases were confirmed by biopsies (15) and clinical follow-up (6) (false-negative rate, 20%). Endoscopic bile duct brushing is diagnostically accurate and hence clinically useful in the management of patients with bile duct strictures. Atypical hyperplasias may contribute to diagnostic pitfalls leading to false-positive and false-negative diagnoses.

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