Endoscopic diagnosis of biliary tract disease

Kalaitzakis, Evangelos; Webster, George

doi:10.1097/mog.0b013e328351436e

Cited by 13 publications

(6 citation statements)

References 65 publications

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“…1,2 When a patient with a biliary stricture is approached, ERCP is used initially. 1 ERCP-based diagnosis of biliary stricture through use of either brush cytology or intraductal biopsies is limited by their poor sensitivity. Hence a significant proportion of strictures remain indeterminate, which has led to development of cholangioscopy-based techniques.…”

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confidence: 99%

Single-operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate biliary strictures: a systematic review

Navaneethan¹,

Hasan²,

Lourdusamy³

et al. 2015

Gastrointestinal Endoscopy

235

170

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Background and Aims Evaluation of indeterminate biliary strictures by brush cytology and intraductal biopsies is limited by low sensitivity. The utility of SpyGlass peroral cholangioscopy for diagnosis of malignant biliary strictures and cholangiocarcinoma (CCA), in particular, remains unclear. Our aim was to study the utility of SpyGlass peroral cholangioscopy and targeted biopsy for diagnosis of malignant biliary strictures and CCA. Methods In this systematic review, PubMed and Embase databases were reviewed for studies published to October 2014. The main outcomes of interest were sensitivity, specificity, and diagnostic odds ratio (DOR) of SpyGlass cholangioscopy in the diagnosis of malignant biliary strictures. Results The search yielded 10 studies involving 456 patients. The pooled sensitivity and specificity of cholangioscopy-guided biopsies in the diagnosis of malignant biliary strictures was 60.1% (95% confidence interval [CI], 54.9%-65.2%) and 98.0% (95% CI, 96.0%-99.0%), respectively. The pooled DOR to detect malignant biliary strictures was 66.4 (95% CI, 32.1-137.5). Four studies included patients who had previous negative imaging and brushings and/or intraductal biopsies. Among these 4 studies, the pooled sensitivity and specificity for diagnosis of malignant biliary strictures was 74.7% (95% CI, 63.3%-84.0%) and 93.3% (95% CI, 85.1%-97.8%), respectively. The pooled DOR was 46.0 (95% CI, 15.4-138.1). Only 1 study directly compared the yield of SpyBite biopsies with standard brushings and biopsies. SpyBite biopsies had a sensitivity of 76.5% compared with brushings (5.8%) and biopsies (29.4%). Six studies specifically reported the role of cholangioscopy with targeted biopsies in the diagnosis of CCA. The pooled sensitivity and specificity to detect CCA was 66.2% (95% CI, 59.7%-72.3%) and 97.0% (95% CI, 94.0%-99.0%), respectively. The pooled DOR to detect CCA was 79.7 (95% CI, 32.7-194.7). Conclusions Our study suggests that SpyGlass cholangioscopy with SpyBite biopsies has moderate sensitivity for the diagnosis of malignant biliary strictures.

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mentioning

confidence: 99%

Single-operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate biliary strictures: a systematic review

Navaneethan¹,

Hasan²,

Lourdusamy³

et al. 2015

Gastrointestinal Endoscopy

235

170

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“…The cholangiographic features of IgG4-SC are similar to those of both PSC and CCA [ 6 ]; diagnosis based on ERC appearances alone may be unreliable [ 48 ]. The possibly confusing conditions are described separately below.…”

Section: Igg4-related Sclerosing Cholangitismentioning

confidence: 99%

Immunoglobulin G4-related sclerosing cholangitis

Goodchild

Pereira

Webster

2018

Korean J Intern Med

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Immunoglobulin G4-related disease (IgG4-RD) is a systemic fibroinflammatory condition of which IgG4-related sclerosing cholangitis (IgG4-SC) is the biliary manifestation. In this review, we provide an overview of IgG4-RD, with a focus on the biliary manifestations. In particular, we describe the important differential diagnoses of IgG4-SC, namely, primary sclerosing cholangitis and cholangiocarcinoma, outline diagnostic criteria for IgG4-SC, provide insight into possible pathophysiological mechanisms underlying the disease and discuss short and long-term management options of this recently described disease.

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“…Recently, endoscopy‐based therapies have commonly been used in cholelithiasis therapy. However, the application of endoscopic retrograde cholangiopancreatography (ERCP) on hepatolithiasis is limited by its indirect vision . What's more, other kinds of cholangioscopic lithotomies are lacking of approach: It is too risky to carry out choledochojejunostomy in a normal‐diameter duct, whereas percutaneous transhepatic cholangioscopy takes time and leaves injuries.…”

Section: Brief Explanationmentioning

confidence: 99%

Peroral cholangioscopy‐guided laser lithotripsy to treat regional hepatolithiasis without stricture

Liu

Zhang

Liu

2018

Digestive Endoscopy

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Hepatectomy is the golden standard in treating hepatolithiasis.1 However, when the stones obstruct a certain segment of the liver, hepatectomy is technically difficult. Moreover, for patients without significant lessening of liver volume nor stricture of obstructed ducts, treatment having the advantage of minimal invasion, faster recovery and the greatest preservation of uninvolved liver is highly desirable. Peroral cholangioscopy (POCS) can provide images of distal ducts

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Endoscopic diagnosis of biliary tract disease

Abstract: Recent technical advances as well as ancillary diagnostic methods have improved the diagnostic accuracy of conventional endoscopic techniques. Future refinement of endoscopic methods may further improve diagnostic approaches to biliary disease.

Cited by 13 publications

References 65 publications

Single-operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate biliary strictures: a systematic review

Single-operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate biliary strictures: a systematic review

Immunoglobulin G4-related sclerosing cholangitis

Peroral cholangioscopy‐guided laser lithotripsy to treat regional hepatolithiasis without stricture

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