Diagnostic utility of single-user peroral cholangioscopy in sclerosing cholangitis

Kalaitzakis, Evangelos; Sturgess, Richard; Kaltsidis, Harry; Oppong, Kofi; Lekharaju, Venkata; Bergenzaun, Per; Vlavianos, Panagiotis; Sharma, Hemant; Westaby, David; Webster, George

doi:10.3109/00365521.2014.936032

Cited by 37 publications

(25 citation statements)

References 29 publications

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“…Similarly, high rates of stone clearance have been reported for direct cholangioscopy, albeit in smaller studies 113. Cholangioscopy is safe but cholangitis has been reported to occur in up to 9% of patients,112 necessitating the use of prophylactic antibiotics. Otherwise complications are comparable to conventional ERCP 114.…”

Section: Endoscopic Management Of Cbdsmentioning

confidence: 93%

Updated guideline on the management of common bile duct stones (CBDS)

Williams

Beckingham

Sayed

et al. 2017

Gut

Self Cite

357

293

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Section: Endoscopic Management Of Cbdsmentioning

confidence: 93%

Updated guideline on the management of common bile duct stones (CBDS)

Williams

Beckingham

Sayed

et al. 2017

Gut

Self Cite

357

293

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“…However, transpapillary cholangioscopy may increase the ability to distinguish between malignant and benign bile duct stenoses in patients with PSC through targeted-biopsies [16] and may be considered in unclear cases. Cholangioscopy seems equally accurate in cancer diagnosis in sclerosing cholangitis (PSC and IgG4-related sclerosing cholangitis) compared to patients with single bile duct strictures [18]. In this retrospective multi-centre caseecontrol study, cholangioscopy showed similar sensitivity, specificity, and accuracy for cancer diagnosis [18].…”

Section: Cholangioscopymentioning

confidence: 69%

“…Cholangioscopy seems equally accurate in cancer diagnosis in sclerosing cholangitis (PSC and IgG4-related sclerosing cholangitis) compared to patients with single bile duct strictures [18]. In this retrospective multi-centre caseecontrol study, cholangioscopy showed similar sensitivity, specificity, and accuracy for cancer diagnosis [18]. However, the insertion of the cholangioscope is technically challenging and may be complicated or even impossible by tight distal strictures and post-procedural cholangitis is more frequent in patients with sclerosing cholangitis [18].…”

Section: Cholangioscopymentioning

confidence: 75%

“…In this retrospective multi-centre caseecontrol study, cholangioscopy showed similar sensitivity, specificity, and accuracy for cancer diagnosis [18]. However, the insertion of the cholangioscope is technically challenging and may be complicated or even impossible by tight distal strictures and post-procedural cholangitis is more frequent in patients with sclerosing cholangitis [18]. The development and improvement of peroral cholangioscopy has led to a growing application of this system.…”

Section: Cholangioscopymentioning

confidence: 94%

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Endoscopic diagnosis of cholangiocarcinoma: From endoscopic retrograde cholangiography to bile proteomics

Voigtländer

Lankisch

2015

Best Practice & Research Clinical Gastroenterology

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“…This technique has high sensitivity and specificity for the diagnosis of biliary strictures [30]. A study by Fukuda et al [31] showed that the sensitivity of combined ERCP/oral cholangioscopy in diagnosing biliary lesions was 93% compared with only 58% for ERCP alone [32].…”

Section: Discussionmentioning

confidence: 99%

Biliary Brush Cytology Revisited

Mehmood

Loya²,

Yusuf³

2016

Acta Cytologica

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Purpose: To evaluate the diagnostic yield of biliary brush cytology and the factors affecting positive results in patients with biliary strictures. Patients and Methods: The medical records of all patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) with biliary brush cytology at our institution from November 2004 to December 2013 were reviewed in this retrospective study. The yield of positive brush cytology and the factors affecting positive yield, such as stricture location, age, gender and preprocedure CA 19.9 level were assessed. The final histopathology, diagnosis obtained by other methods, such as endoscopic ultrasound-guided fine-needle aspiration cytology, CT scan, Tru-Cut biopsy and/or clinical/radiological follow-up were used to identify true- and false-positive/negative results. The brush cytology results were divided into 4 main categories: malignant, benign, atypical cells and inadequate. Results: A total of 1,168 patients underwent ERCP during this 9-year period. Out of these, 142 patients had ERCP and biliary brushings for diagnosis. The mean age of the patients at presentation was 58.7 years (range 23-84 years; 64.8% males). The indication for referral was obstructive jaundice in all patients. Of the 142 patients, 77 (54.2%) had a distal common bile duct (CBD) stricture and 65 (45.8%) had a proximal /complex hilar stricture. The strictures were classified as proximal or distal, based on their relationship with the cystic duct; those below the cystic duct insertion were classified as distal and those above it were considered proximal. The diagnostic yield of brush cytology was 58.5%. The diagnostic yield was higher for proximal than for distal CBD strictures (67 vs. 50%; p = 0.047). It was also higher for females (58 vs. 57.6%; p = 0.94), patients >50 years (60 vs. 50%; p = 0.29) and those with a CA 19.9 level >300 IU/ml (59.4 vs. 55.5%; p = 0.65) but did not reach statistical significance for any of these parameters. Complete follow-up data were available for 96 patients and 46 patients were lost to follow-up. The sensitivity, specificity, positive predictive value and negative predictive value were 65.3, 100, 100 and 27%, respectively. When patients with atypia were included in the group with positive results, the diagnostic yield increased to 65.5% with a diagnostic sensitivity of 68.6%. There were 27 false-negative diagnoses, 10 patients were true-negative and no patients had a false-positive diagnosis. Conclusion: Biliary brush cytology is a safe and simple initial diagnostic procedure in patients with biliary strictures and can be performed at the time of therapeutic ERCP. If performed correctly and then interpreted by a dedicated cytopathologist, it has a good diagnostic yield and sensitivity. We feel that the low rates of success with this technique reported in some earlier studies have led to a feeling that this is not a particularly useful technique. We recommend that this topic should be revisited, and that the technique should be used more often.

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Diagnostic utility of single-user peroral cholangioscopy in sclerosing cholangitis

Abstract: SOC is equally accurate in cancer diagnosis in sclerosing cholangitis and patients with single biliary strictures. However, cholangioscope insertion may be hampered by bile duct narrowing and post-SOC cholangitis is more common in sclerosing cholangitis.

Cited by 37 publications

References 29 publications

Updated guideline on the management of common bile duct stones (CBDS)

Updated guideline on the management of common bile duct stones (CBDS)

Endoscopic diagnosis of cholangiocarcinoma: From endoscopic retrograde cholangiography to bile proteomics

Biliary Brush Cytology Revisited

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