Automatic Identification of Papillary Projections in Indeterminate Biliary Strictures Using Digital Single-Operator Cholangioscopy

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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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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You cannot go wrong: choosing digital single-operator cholangioscopy for the diagnosis of biliary strictures

Endoscopy ◽

10.1055/a-1106-7246 ◽

2020 ◽

Vol 52 (03) ◽

pp. 168-169

Author(s):

Udayakumar Navaneethan

Keyword(s):

Biliary Strictures ◽

Single Operator

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Tu1412 Single Operator Cholangioscopy for the Evaluation and Diagnosis of Indeterminate Biliary Strictures - Results From a Large Multi-National Registry

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2017.03.1419 ◽

2017 ◽

Vol 85 (5) ◽

pp. AB615

Author(s):

Mohan K. Ramchandani ◽

Mahesh K. Goenka ◽

Takao Itoi ◽

Dong Wan Seo ◽

Rungsun Rerknimitr ◽

...

Keyword(s):

National Registry ◽

Biliary Strictures ◽

Single Operator

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

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2016.03.1497 ◽

2016 ◽

Vol 84 (4) ◽

pp. 681-687 ◽

Cited By ~ 30

Author(s):

Shyam Varadarajulu ◽

Ji Young Bang ◽

Muhammad K. Hasan ◽

Udayakumar Navaneethan ◽

Robert Hawes ◽

...

Keyword(s):

Diagnostic Yield ◽

Biliary Strictures ◽

Guided Biopsy ◽

Single Operator

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Sa1438 DIAGNOSTIC UTILITY OF DIGITAL SINGLE-OPERATOR CHOLANGIOSCOPY IN THE EVALUATION OF INDETERMINATE BILIARY STRICTURES: A SINGLE CENTER COHORT STUDY

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2019.03.233 ◽

2019 ◽

Vol 89 (6) ◽

pp. AB230-AB231

Author(s):

Raymond S. Tang ◽

Anthony Y. Teoh ◽

Kit F. Lee ◽

Thomas Y. Lam ◽

Philip Wai Yan W. Chiu ◽

...

Keyword(s):

Cohort Study ◽

Diagnostic Utility ◽

Single Center ◽

Biliary Strictures ◽

Single Operator

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Clinical impact of digital cholangioscopy in management of indeterminate biliary strictures and complex biliary stones: a single-center study

Therapeutic Advances in Gastrointestinal Endoscopy ◽

10.1177/2631774519853160 ◽

2019 ◽

Vol 12 ◽

pp. 263177451985316 ◽

Cited By ~ 4

Author(s):

Stephanie Yan ◽

Sooraj Tejaswi

Keyword(s):

Primary Sclerosing Cholangitis ◽

Patient Outcomes ◽

Sclerosing Cholangitis ◽

Patient Characteristics ◽

Clinical Impact ◽

Endoscopic Management ◽

Biliary Strictures ◽

Brush Cytology ◽

Biliary Stones ◽

Single Operator

Aims: Endoscopic management of indeterminate strictures and complex stones remains a challenge, for which the latest generation single-operator digital cholangioscope (SpyGlass DS) has shown promising results. We aimed to study the clinical impact of single-operator digital cholangioscope at our tertiary academic center. Methods: We retrospectively reviewed all digital cholangioscopies performed from June 2015 to May 2018. Patient characteristics, procedure characteristics, and post-procedural patient outcomes were recorded. Results: A total of 50 patients (26 men, average age 61.4 years) underwent 67 procedures. Indications were biliary stones (21/50, 42%), strictures and primary sclerosing cholangitis surveillance (22/50, 46%), and miscellaneous (7/50, 14%). The average procedure time was 82 ± 29 min (99.5 min for stones and 74.2 min for strictures). Stone clearance was achieved in 19/21 (90.47%) cases, with electrohydraulic lithotripsy employed in 16/21 and repeat cholangioscopy necessary in 9/21. Malignant strictures (10) were differentiated from benign (12) in all cases both in patients with primary sclerosing cholangitis (9) and in those without (13), based on visual cholangioscopic features (sensitivity and specificity 100%), single-operator digital cholangioscope–directed biopsies (sensitivity 60% and specificity 100%), and brush cytology (sensitivity 37.5% and specificity 100%). Complications included one post-sphincterotomy bleeding and one post-procedural cholangitis despite antibiotic prophylaxis, but no procedure-related mortality. Conclusion: Single-operator digital cholangioscope had a high success rate and a low rate of complications for management of indeterminate strictures and difficult biliary stones. Visual cholangioscopic features of biliary strictures had excellent diagnostic accuracy, and targeted biopsies outperformed brush cytology. Early implementation of cholangioscopy for select indications leads to successful patient outcomes and reduces diagnostic delays, cost, and risks of repeat endoscopic retrograde cholangiopancreatographies.

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