Diagnostic accuracy and interobserver agreement of digital single-operator cholangioscopy for indeterminate biliary strictures

Stassen, Pauline M.; Goodchild, George; Jonge, P.J.F. de; Erler, Nicole S.; Anderloni, Andrea; Cennamo, Vincenzo; Church, Nicholas I.; Sainz, Ignacio Fernández-Urién; Huggett, Matthew T.; James, Martin; Joshi, Deepak; Kylänpää, Leena; Laleman, Wim; Nayar, Manu; Oppong, Kofi; Poley, Jan–Werner; Potts, Jonathan R.; Repici, Alessandro; Udd, Marianne; Vila, Juan J.; Wong, Terence Z.; Bruno, Marco J.; Webster, George

doi:10.1016/j.gie.2021.06.027

Cited by 27 publications

(17 citation statements)

References 22 publications

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“…Recently, a digital single-operator POCS with improved maneuverability and imaging quality was introduced in clinical practice [16,17]. However, the accuracy of visual interpretation of biliary strictures via digital POCS is still controversial, with some studies reporting low diagnostic value and considerable interobserver variation [18 ▪ ,19]. Therefore, a targeted biopsy is required for precise assessment of indeterminate biliary strictures [20,21].…”

Section: Diagnosis Of Biliary Stricturesmentioning

confidence: 99%

Current endoscopic approaches to biliary strictures

Shimoda

Nakai

Fujishiro

2022

Current Opinion in Gastroenterology

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Purpose of reviewTo summarize the current status and future perspectives of the endoscopic management of biliary strictures.Recent findingsIn addition to conventional diagnostic modalities, such as cross-sectional imaging and endoscopic ultrasonography (EUS), per-oral cholangioscopy is helpful for indeterminate biliary strictures. It allows direct visualization of the biliary tract and targeted biopsy. For distal malignant biliary obstruction (MBO), a self-expandable metal stent (SEMS) via endoscopic retrograde cholangiopancreatography (ERCP) is a standard of care. EUS-guided biliary drainage (EUS-BD) is an emerging alternative to percutaneous transhepatic biliary drainage in cases with failed ERCP. EUS-BD is also an effective salvage option for perihilar MBO, which can not be managed via ERCP or percutaneous transhepatic biliary drainage. Preoperative drainage is necessary for most jaundiced patients as neoadjuvant chemotherapy is widely administered for resectable and borderline resectable pancreatic cancer, and a SEMS is preferred in this setting, too. For benign biliary strictures, a covered SEMS can improve stricture resolution and reduce the number of endoscopic sessions as compared to plastic stents.SummaryERCP and EUS play a central role in the diagnosis and drainage for both malignant and benign biliary strictures.

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Section: Diagnosis Of Biliary Stricturesmentioning

confidence: 99%

Current endoscopic approaches to biliary strictures

Shimoda

Nakai

Fujishiro

2022

Current Opinion in Gastroenterology

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“…Similarly, another report shows a low sensitivity for DSOC visual impressions of IBDS and had a considerable interobserver variation, in which, about 27% of patients with PSC, but the diagnostic accuracy had no signi cant difference even if excluded the patients with PSC 14 . Therefore, accurate diagnosis of IBDS can not only rely on DSOC visual impression, and biopsies are necessary.…”

Section: Discussionmentioning

confidence: 88%

Improved fluoroscopy-guided biopsies in the diagnosis of indeterminate biliary strictures: A multi-center retrospective study

Xiong

Wang²,

Zhang

et al. 2022

Preprint

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Aim To evaluate the diagnostic accuracy of improved fluoroscopy-guided biopsies for indeterminate biliary strictures (IBDS). Methods A multi-center retrospective study was performed. Patients with IBDS who underwent digital single-operator cholangioscopy (DSOC) and improved fluoroscopy-guided biopsies procedures were included. The individual sensitivity, specificity, and accuracy were analyzed. Results A total of 67 patients were enrolled in this multi-center retrospective study. The DSOC and improved fluoroscopy-guided biopsies procedures were successfully performed in all cases (100%). The sensitivity, specificity, and accuracy values were 83.3%, 89.5%, and 85.1% for DSOC visual impression; 95.8%, 94.7%, and 95.5% for improved fluoroscopy-guided biopsies procedures, respectively. The sensitivity and accuracy of improved fluoroscopy-guided biopsies were significantly higher compared with DSOC visual impression. Four patients (6.0%, 4/67) occurred adverse events after the procedures. Conclusions Improved fluoroscopy-guided biopsies had a high diagnostic accuracy of IBDS diagnosis.

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“…However, it has been reported that the diagnostic performance of direct‐vision biopsy under the POCS is still inadequate for a final histopathological diagnosis, having a sensitivity of 58%–100% and a specificity of 80%–100% 14 . Contributing factors were suggested to be the instability of the image caused by blood and mucus adhering to the optical fiber and the fact that the conventional POCS biopsy forceps, which have an outer diameter of about 1 mm, typically obtain only a small amount of tissue and have a low sampling rate 22 . With nMB‐POCS, it is possible to improve the clarity of vision by suction with a large accessory channel, and use biopsy forceps up to 1.8 mm, such as those used for upper gastrointestinal endoscopy, which are expected to further improve diagnostic performance.…”

Section: Discussionmentioning

confidence: 99%

A novel peroral digital cholangioscope with a large accessory channel: An experimental study

Tonozuka

Itoi

Nagai

et al. 2022

J Hepato Biliary Pancreat

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Endoscopic retrograde cholangiopancreatography (ERCP) is among the essential imaging modalities for diagnosis and treatment of biliary disorders. However, it is sometimes difficult to diagnose and treat patients using only indirect two-dimensional images obtained by fluoroscopic imaging. In such cases, a peroral cholangioscope (POCS) can be used to insert an endoscope into the bile duct for direct visualization. [1][2][3][4] Use of the POCS has been increasing due to improvements in functionality, image quality, and operability as well as the development of related devices. The POCS methodology is divided into two main types: one using the "mother-baby" peroral cholangioscope (MB-POCS), in which an ultra-thin scope with an outer diameter of 3.5-4.0 mm is inserted via the transpapillary route through the accessory channel of a sideviewing duodenoscope; 5-7 and the other using a peroral

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Diagnostic accuracy and interobserver agreement of digital single-operator cholangioscopy for indeterminate biliary strictures

Cited by 27 publications

References 22 publications

Current endoscopic approaches to biliary strictures

Current endoscopic approaches to biliary strictures

Improved fluoroscopy-guided biopsies in the diagnosis of indeterminate biliary strictures: A multi-center retrospective study

A novel peroral digital cholangioscope with a large accessory channel: An experimental study

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