Efficacy of digital single-operator cholangioscopy and factors affecting its accuracy in the evaluation of indeterminate biliary stricture

Jang, Sunguk; Stevens, Tyler; Kou, Lei; Vargo, John J.; Parsi, Mansour A.

doi:10.1016/j.gie.2019.09.015

Cited by 27 publications

(23 citation statements)

References 26 publications

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“…▶ FISH, with a sensitivity of 44 % [9], use of digital single-operator cholangioscopy, with recent reports of a sensitivity for visual interpretation ranging between 64 % [11] and 89.1 % [14], and for bile duct sampling under cholangioscopic guidance, with sensitivity ranging between 15 % [11] and 69.8 % [14]. Data are extremely limited on application of ROSE in cases other than EUS-FNA.…”

Section: Discussionmentioning

confidence: 99%

High sensitivity of ROSE-supported ERCP-guided brushing for biliary strictures

Mariani

Ciambriello²,

Petrone

et al. 2021

Endosc Int Open

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Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) plays a major role in biliary strictures, with brushing being a cheap and fast method to acquire a cytological specimen, despite a sensitivity around 45 %. Rapid on-site evaluation (ROSE) is widely used for endoscopic ultrasound-acquired cytological specimen adequacy, improving its sensitivity and specificity. Nevertheless, no study has evaluated its role for ERCP-guided brushing. Our aim was to assess the diagnostic yield of ERCP-guided brushing of biliary strictures when supported by ROSE. Patients and methods This was a retrospective single-center study that included patients undergoing ERCP-guided brush cytology supported by ROSE for biliary strictures. Recorded data included patient clinical-radiological and ERCP features. Final diagnosis was determined after surgery, intraductal biopsy or adequate follow-up. The diagnostic yield was calculated and a subgroup analysis for factors associated with false-negative or true-positive results was performed. Results Two hundred six patients were included, 57.3 % males, median age 72 years, 77.2 % having extrahepatic biliary strictures. Of the patients, 99 % had an adequate sample at ROSE after a mean of 2.6 passages. The diagnostic yield was accuracy 83 %, sensitivity 74.6 %, and specificity 98 %, positive and negative predictive values 98 % and 71 % respectively, with an area under the curve of 0.86. A diagnosis of cholangiocarcinoma was significantly more frequent among true-positive cases (68 % vs 46.8 %; P = 0.04). Conclusions This is the first study evaluating the use of ROSE as support for ERCP-guided brushing of biliary strictures, with a sensitivity far higher than those reported for brushing alone and at least comparable to those of more expensive and invasive techniques.

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Section: Discussionmentioning

confidence: 99%

High sensitivity of ROSE-supported ERCP-guided brushing for biliary strictures

Mariani

Ciambriello²,

Petrone

et al. 2021

Endosc Int Open

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“…Recently, a systematic review [35] demonstrated diagnostic performance of different cholangioscopes in patients with biliary strictures and emphasized the high diagnostic performance of digital singleoperator cholangioscope (SpyGlass DS; Boston Scientific Corp.) with improved image quality compared to the fibroptic cholangioscope (SpyGlass; Boston Scientific Corp.). In particular, the advantage of the digital singleoperator cholangioscope is that biopsy can be performed under direct visualization while irrigating saline solution, and its sensitivity and specificity in the diagnosis of malignant biliary stricture have been reported to be 68-85% and 98-100%, respectively [36][37][38]. However, the dual-operator video cholangioscope has better image quality than single-operator digital cholangioscope and is more suitable for evaluating the characteristics of biliary strictures.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of peroral cholangioscopy in the differential diagnosis of IgG4-related sclerosing cholangitis and extrahepatic cholangiocarcinoma: a single-center retrospective study

et al. 2020

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Background: In the diagnosis of IgG4-related sclerosing cholangitis (IgG4-SC), differentiation from extrahepatic cholangiocarcinoma (ECC) is extremely important but is still a clinical challenge. This study aimed to elucidate the usefulness of peroral cholangioscopy (POCS) for the differential diagnosis between IgG4-SC and ECC. Methods: POCS findings for bile duct stricture were retrospectively evaluated in 17 patients with IgG4-SC diagnosed at the Hiroshima University Hospital and 53 patients with surgically resected infiltrating ECC. Mucosal surface, dilated vessels (tortuosity, caliber alteration, and disruption), and easily bleeding were compared between the groups. Results: The stricture sites of IgG4-SC evaluated by POCS were 10 extrapancreatic bile ducts and 9 intrapancreatic bile ducts. In patients with IgG4-SC, smooth mucosal surface was observed in 89% (17/19), dilated vessels in 58% (11/19) [tortuosity 82% (9/11), caliber alteration 18% (2/11), and disruption 9% (1/11)], and easily bleeding in 0%. Irregular mucosal surface and easily bleeding were observed significantly more frequently in ECC (both P < 0.001). The frequency of caliber alteration and disruption of dilated vessels was significantly less in IgG4-SC (P < 0.001 and 0.005, respectively). The sensitivity and specificity of POCS in the diagnosis of ECC were 96 and 89%, respectively. Dilated vessels in IgG4-SC were observed significantly more frequently in the extrapancreatic bile duct, especially the hilar bile duct (P = 0.006). Concerning image evaluation, the interobserver agreement was κ = 0.719, and the intraobserver agreement was κ = 0.768 and 0.754. Conclusions: Characteristic POCS findings of the stricture sites in IgG4-SC were smooth mucosal surface, dilated vessels without caliber alteration and disruption, and lack of easily bleeding. These POCS findings are extremely useful for distinguishing between IgG4-SC and ECC.

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“…A systematic review and meta-analysis by Njei et al (13) involving 169 PSC patients demonstrated that although SOC-guided biopsy had high specificity (97%) and accuracy (96%), its sensitivity for the diagnosis of cholangiocarcinoma was limited at 65%. The multivariate analysis from a retrospective study by Jang et al (14) demonstrated that serum total bilirubin of >3.2 mg/dL had a negative impact on both visual impression and targeted biopsy. Furthermore, endoscopists' experience of >50 cholangioscopies was associated with an improvement in both visual impression and targeted-biopsy diagnostic accuracy (14).…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

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

Angsuwatcharakon

Kulpatcharapong

Moon

et al. 2022

HPB

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show abstract

Efficacy of digital single-operator cholangioscopy and factors affecting its accuracy in the evaluation of indeterminate biliary stricture

Cited by 27 publications

References 26 publications

High sensitivity of ROSE-supported ERCP-guided brushing for biliary strictures

High sensitivity of ROSE-supported ERCP-guided brushing for biliary strictures

Usefulness of peroral cholangioscopy in the differential diagnosis of IgG4-related sclerosing cholangitis and extrahepatic cholangiocarcinoma: a single-center retrospective study

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

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