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

Abstract

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.

Experiencia en colangioscopia digital peroral con SpyGlass DS en diferentes centros de referencia en gastroenterología y endoscopia digestiva en Colombia: Serie de casos

“…Las altas tasas de resolución, la tasa de eventos adversos y la disminución de los tiempos de estancia intrahospitalaria se acercan a estudios anteriores (17,26,27) , por lo que es una alternativa a tener en cuenta en el protocolo de manejo de los pacientes con indicación de esta tecnología. Mientras que, las tasas de colangitis aguda post-CPO es baja, en relación a prácticas como la administración intravenosa de antibióticos y el drenaje nasobiliar (17,26,28) . La comparación entre el uso de la litotricia con el láser o la LEH no muestra grandes diferencias en sus resultados.…”

Choledochoscopy: An update

“…There is a significant discrepancy in the incidence of partially enlarged vessels and dilated vessels between IgG4-SC patients and distal CCA ( P = 0.004) and hilar CCA ( P = 0.015)[ 70 ]. Another study by Ishii et al [ 71 ] using peroral videocholangioscopes on 17 IgG4-SC and 53 CCA patients reported that the use of vessel morphology seen on choledochoscopy could distinguish IgG4-SC patients from CCA patients with sensitivity (96%), specificity (89%), interobserver agreement (κ = 0.719), and the intraobserver agreement (κ = 0.768 and 0.754).…”

Direct peroral cholangioscopy with narrow band imaging via endoscopic ultrasound‐guided hepaticogastrostomy route in malignant choledochojejunostomy anastomotic stricture

“…2). 1 After biopsies under direct visualization, we exchanged the scope with the duodenoscope and dilated the stricture using an 8‐mm balloon catheter (REN; Kaneka Medix, Osaka, Japan). Finally, two plastic stents were placed across the fistula (Video S1).…”