Cholangioscopy Is Safe and Feasible in Elderly Patients

Bernica, Jessica; Elhanafi, Sherif; Kalakota, Neeharika; Jia, Yi; Dodoo, Christopher; Dwivedi, Alok; Sealock, Robert J.; Patel, Kalpesh; Raijman, Isaac; Zuckerman, Marc J.; Othman, Mohamed O.

doi:10.1016/j.cgh.2018.02.032

Cited by 10 publications

(8 citation statements)

References 30 publications

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“…dSOCs have been demonstrated to be a safe procedure, also in elderly patients. Diagnostic accuracy of dSOC-directed biopsies is higher than brush cytology in obtaining a histological diagnosis of unclear biliary strictures and alterations [12,14,20].…”

Section: Discussionmentioning

confidence: 96%

Diagnostic Accuracy and Therapeutic Efficacy of Digital Single-Operator Cholangioscopy for Biliary Lesions and Stenosis

Weigand¹,

Küchle²,

Zuber-Jerger³

et al. 2021

Digestion

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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.

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Section: Discussionmentioning

confidence: 96%

Diagnostic Accuracy and Therapeutic Efficacy of Digital Single-Operator Cholangioscopy for Biliary Lesions and Stenosis

Weigand¹,

Küchle²,

Zuber-Jerger³

et al. 2021

Digestion

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“…Cholangioscopy has been assessed by many studies to be a safe procedure even in elderly and comorbid patients. 32,33 Despite its diagnostic utility, the uptake of cholangioscopy has been relatively limited in many endoscopy centers. Many endoscopists perceive the procedure to be technically difficult, as it requires mastery in ERCP while concurrently operating the cholangioscope through the working channel.…”

Section: Cholangioscopymentioning

confidence: 99%

Recent advances of diagnostic approaches for indeterminate biliary tract obstruction

Cha

2021

Int J Gastrointest Interv

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Patients with indeterminate biliary stricture frequently pose a challenge in the clinical management. Discrimination between benign and malignant biliary strictures is important to prevent the morbidity and mortality associated with incorrect diagnoses. Traditional tissue sampling using endoscopic retrograde cholangiography does not always produce a definitive diagnosis, with a considerable proportion of cases remaining as indeterminate biliary strictures. Recent advances in endoscopic and molecular techniques have the potential to improve the diagnostic and prognostic accuracy of biliary strictures. This article reviews various etiologies of biliary strictures and discusses the recent advances of diagnostic approaches for indeterminate biliary tract obstruction.

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“…There were two main outcomes of this study: the success rate of ERCP and the complication rate of ERCP. According to the classi cations described by Ridtitid et al [21], ERCP can be classi ed as a complete success, partial success, or failure. ERCP complete success is achieved if all expected diagnostic and therapeutic measures are performed, including complete stone removal or PD drainage.…”

Section: Outcome Measuresmentioning

confidence: 99%

Increased Severity of Complications After Therapeutic ERCP in Geriatric Patients With Chronic Pancreatitis: An Observational Study

Guo¹,

Zou²,

Zhu³

et al. 2021

Preprint

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Background: Studies of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in geriatric patients have mainly examined patients with biliary diseases, rather than chronic pancreatitis (CP). This study aimed to evaluate the safety and success rate of therapeutic ERCP in geriatric patients with CP. Methods: This was an observational study from prospectively collected data. The medical records of patients with CP aged over 65 years (Group A) were collected in a tertiary hospital from January 2013 to December 2018. Sex-matched CP patients under 65 years (Group B) were randomly selected into the control group (matching ratio = 1:2). Collected data included demographic data, endoscopic findings, interventions, success, and complications. The success rate and the complication rate of therapeutic ERCP in two groups were compared with chi-square test. The risk factors for post-ERCP pancreatitis were investigated by univariate and multivariate analysis.Results: A total of 268 ERCPs were performed in 179 patients of Group A and 612 ERCPs in 358 patients of Group B. The success rate of ERCP in Group A was similar to that of Group B (92.16% vs 92.32%; P=0.936). The overall incidence of post-ERCP complications was 7.09% (19/268) and 5.72% (35/612) in Group A and B, respectively (P=0.436). However, geriatric patients had a significantly increased occurrence of moderate to severe complications (2.61% vs 0.16%; P=0.002). Female gender (OR=3.40; 95% CI, 1.02-11.31; P=0.046), pancreas divisum (OR=7.15; 95% CI, 1.01-50.62; P=0.049), dorsal pancreatogram (OR=7.40; 95% CI, 1.63-33.64; P=0.010), and lithotripsy (OR=0.15; 95% CI, 0.03-0.70; P=0.016) were significantly associated with risk of post-ERCP pancreatitis in geriatric patients.Conclusions: Therapeutic ERCP is safe and feasible in elderly patients with CP. However, occurrence of moderate to severe complications after ERCP increased in geriatric patients.Trial registration: retrospectively registered.

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Cholangioscopy Is Safe and Feasible in Elderly Patients

Cited by 10 publications

References 30 publications

Diagnostic Accuracy and Therapeutic Efficacy of Digital Single-Operator Cholangioscopy for Biliary Lesions and Stenosis

Diagnostic Accuracy and Therapeutic Efficacy of Digital Single-Operator Cholangioscopy for Biliary Lesions and Stenosis

Recent advances of diagnostic approaches for indeterminate biliary tract obstruction

Increased Severity of Complications After Therapeutic ERCP in Geriatric Patients With Chronic Pancreatitis: An Observational Study

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