Consensus guidelines on the role of cholangioscopy to diagnose indeterminate biliary stricture

Abstract

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Current endoscopic approaches to biliary strictures

“…Therefore, a targeted biopsy is required for precise assessment of indeterminate biliary strictures [20,21]. The diagnostic classification should be established for the generalizability of digital POCS diagnosis [22 ▪▪ ,23 ▪ ], and artificial intelligence may help improve the diagnostic yield of POCS [24 ▪ ].…”

Molecular diagnosis of pancreatobiliary tract cancer by detecting mutations and methylation changes in bile samples

“… 8 The limited sensitivity of ERCP-based pathological evaluation may be explained by the inadequate sampling due to the highly desmoplastic, paucicellular nature of CCA and the inaccessible anatomical location. 7 According to the expert consensus, 48 , 49 when patients with suspected malignant biliary strictures undergo ERCP examination but the pathological results do not support malignancy, multiple examinations (e.g., intraductal ultrasonography [IDUS], EUS-FNA, image examination) under the guidance of multi-disciplinary team should be considered to confirm the diagnosis. However, the accuracy of these diagnosis methods is still not satisfying (IDUS, 66% sensitivity; IDUS plus CT, 82% sensitivity and 82% specificity; EUS-FNA, 74% sensitivity).…”

“…However, the accuracy of these diagnosis methods is still not satisfying (IDUS, 66% sensitivity; IDUS plus CT, 82% sensitivity and 82% specificity; EUS-FNA, 74% sensitivity). 48 , 49 , 50 , 51 Thus, the optimal time for treatment might be missed during the follow-up period. It is imperative to enhance the diagnosis accuracy for these patients.…”

Clinical characteristics, risk factors and diagnostic outcomes of patients presented with indeterminate biliary stricture: A multicenter study

“…To our knowledge, this is the first work that studied reasonable number of patients presented with IBS to reflect its current insight in Egypt. Also, in the spotlight of this study, and in order to improve the diagnostic outcome of IBS, several modalities and technologies should be added to the diagnostic armamentarium of IBS such as single operator CS ( 29 , 30 ), intraductal ultrasonography ( 28 , 31 ), confocal laser endomicroscopy (CLE) ( 32 – 36 ), fluorescent in situ hybridization (FISH) ( 37 – 39 ), bile duct fluid biomarkers ( 40 , 41 ), and digital image analysis ( 42 ). However; the study had some limitations including being retrospective, limited number of patients with the final diagnosis achieved, lack of long-term follow up, and missing important data such as the definite treatment, surgical resectability and overall outcome.…”