Cholangioscopy in the digital era

Ayoub, Fares; Yang, Dennis; Draganov, Peter V.

doi:10.21037/tgh.2018.10.08

Cited by 22 publications

(16 citation statements)

References 77 publications

(104 reference statements)

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“…This provides direct, not just fluoroscopic, visualization of the biliary tract [4]. The recent introduction of a single operator digital cholangioscope called Spyglass DS (Boston Scientific Corp) has allowed POCS to become one of the primary tools in diagnosis of MBS [33].…”

Section: Cholangioscopymentioning

confidence: 99%

The Diagnostic Dilemma of Malignant Biliary Strictures

et al. 2020

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The differential diagnosis for biliary strictures is broad. However, the likelihood of malignancy is high. Determining the etiology of a biliary stricture requires a comprehensive physical exam, laboratory evaluation, imaging, and ultimately tissue acquisition. Even then, definitive diagnosis is elusive, and many strictures remain indeterminant in origin. This literary review examines the diagnostic dilemma of biliary strictures and presents innovations in both histochemical and endoscopic techniques that have increased the diagnostic power of differentiating benign and malignant strictures. The field of tissue biopsy is revolutionizing with the advent of free DNA mutation profiling, fluorescence in situ hybridization (FISH), and methionyl t-RNA synthetase 1 (MARS 1), which allow for greater testing sensitivity. Endoscopic ultrasound, endoscopic retrograde cholangiopancreatography (ERCP), cholangioscopy, confocal laser endomicroscopy, and intraductal ultrasound build upon existing endoscopic technology to better characterize strictures that would otherwise be indeterminate in etiology. This review uses recent literature to insert innovative technology into the traditional framework of diagnostic methods for malignant biliary strictures.

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Section: Cholangioscopymentioning

confidence: 99%

The Diagnostic Dilemma of Malignant Biliary Strictures

et al. 2020

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“…[ 11 ] The reported clearance rate of postoperative choledochoscopy for residual calculus in the intrahepatic duct ranges from 90% to 95.5%. [ 12 , 18 , 19 ]…”

Section: Discussionmentioning

confidence: 99%

The postoperative choledochoscopy in the management of the residual hepatolithiasis involving the caudate lobe

Zhuang

Feng

et al. 2021

Medicine

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To reveal the role of the postoperative choledochoscopy in treating the residual calculi in the caudate lobe (CL) of the liver. We recruited 66 patients with T-tube/percutaneous transhepatic cholangioscopy tract who still had residual gallstones in the CL at least 6 weeks after the operation. Imaging examinations determined the gallstones’ locations in the patients, and all of them underwent the postoperative choledochoscopic examination through the T-tube/percutaneous transhepatic cholangioscopy tract for therapeutic intervention. Among the 66 patients, the residual gallstones were mostly located in the Spiegel lobe (48/66, 72.7%), and the residual gallstones that located in the origin of the CL bile branches were successfully determined in the 57 patients (57/66, 86.4%), the remaining 9 patients were unclear because the proximal ducts were severely narrow or even atresia. The mean frequency of the postoperative choledochoscopy was 3.6 (range, 1–10) times. There were 9 patients with complications, and no mortality occurred. In the origin-proved 57 patients, 6 patients failed to remove the gallstones altogether, and the final residual gallstone clearance rate was 77.3% (51/66). There was no significant difference between the Spiegel lobe and the other parts of the CL in determining the bile duct's origins, gallstone clearance rate, and complications. However, the frequency of choledochoscopy in the other parts of the CL was more than in the Spiegel lobe. The postoperative choledochoscopy, an essential method for treating the residual gallstones in the CL, commands high efficiency for calculi extraction and fewer complications. The main reasons for failing to remove the residual gallstones are that the bile duct's origins could not be determined, and the distal bile ducts are atretic in the CL.

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“…However, SOC has some drawbacks. First, the small caliber of the accessory channel (1.2 mm) limits the use of various accessories [5]. Second, if the duct strictures are severe, it may not be possible to advance the equipment to the target lesion [8].…”

Section: Discussionmentioning

confidence: 99%

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

Lee

et al. 2020

Endoscopy

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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.

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Cholangioscopy in the digital era

Cited by 22 publications

References 77 publications

The Diagnostic Dilemma of Malignant Biliary Strictures

The Diagnostic Dilemma of Malignant Biliary Strictures

The postoperative choledochoscopy in the management of the residual hepatolithiasis involving the caudate lobe

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

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