1
|
Sacco M, Gesualdo M, Staiano MT, Dall'Amico E, Caronna S, Dibitetto S, Canalis C, Caneglias A, Mediati F, Stasio RC, Gaia S, Saracco GM, Bruno M, De Angelis CG. Direct Single-Operator Cholangioscopy and Intraductal Ultrasonography in Patients with Indeterminate Biliary Strictures: A Single Center Experience. Diagnostics (Basel) 2024; 14:1316. [PMID: 39001208 PMCID: PMC11240807 DOI: 10.3390/diagnostics14131316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/16/2024] [Accepted: 06/18/2024] [Indexed: 07/16/2024] Open
Abstract
The evaluation of biliary strictures poses a challenge due to the low sensitivity of standard diagnostic approaches, but the advent of direct single-operator cholangioscopy (DSOC) has revolutionized this paradigm. Our study aimed to assess the diagnostic performance of DSOC and DSOC-targeted biopsies, intraductal ultrasound (IDUS), and standard brush cytology in patients with indeterminate biliary strictures (IBS). We reviewed patients who underwent advanced diagnostic evaluation for IBS at our endoscopy unit from January 2018 to December 2022, all of whom had previously undergone at least one endoscopic attempt to characterize the biliary stricture. Final diagnoses were established based on surgical pathology and/or clinical and radiological follow-up spanning at least 12 months. A total of 57 patients, with a mean age of 67.2 ± 10.0 years, were included, with a mean follow-up of 18.2 ± 18.1 months. The majority of IBS were located in the distal common bile duct (45.6%), with malignancy confirmed in 35 patients (61.4%). DSOC and IDUS demonstrated significantly higher accuracies (89.5% and 82.7%, respectively) compared to standard cytology (61.5%, p < 0.05). Both DSOC visualization and IDUS exhibited optimal diagnostic yields in differentiating IBS with an acceptable safety profile.
Collapse
Affiliation(s)
- Marco Sacco
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Marcantonio Gesualdo
- Endoscopy Unit, Gastroenterology Department, Section of Gastroenterology II, National Institute of Research IRCCS "Saverio De Bellis", 70013 Castellana Grotte, Italy
| | - Maria Teresa Staiano
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Eleonora Dall'Amico
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Stefania Caronna
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Simone Dibitetto
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Chiara Canalis
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Alessandro Caneglias
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Federica Mediati
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Rosa Claudia Stasio
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Silvia Gaia
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Giorgio Maria Saracco
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Mauro Bruno
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Claudio Giovanni De Angelis
- Endoscopy Unit, Gastroenterology Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| |
Collapse
|
2
|
Peveling-Oberhag J, Zimmermann C, Linzenbold W, Ott G, Enderle M, Albert JG. Bile duct tissue acquisition by cholangioscopy-guided cryobiopsy technique: first-in-human application. VideoGIE 2023; 8:158-161. [PMID: 37095838 PMCID: PMC10122066 DOI: 10.1016/j.vgie.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Video 1Case description and video in cholangioscopic view demonstrating bile duct tissue acquisition by cholangioscopy-guided cryobiopsy technique.
Collapse
|
3
|
Ogura T, Hirose Y, Ueno S, Okuda A, Nishioka N, Miyano A, Yamamoto Y, Ueshima K, Higuchi K. Prospective registration study of diagnostic yield and sample size in forceps biopsy using a novel device under digital cholangioscopy guidance with macroscopic on‐site evaluation. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 30:686-692. [DOI: 10.1002/jhbp.1247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/25/2022] [Accepted: 09/12/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Takeshi Ogura
- 2nd Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
| | - Yoshinobu Hirose
- Department of Pathology Osaka Medical and Pharmaceutical University Osaka Japan
| | - Saori Ueno
- 2nd Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
| | - Atsushi Okuda
- 2nd Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
| | - Nobu Nishioka
- 2nd Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
| | - Akira Miyano
- 2nd Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
| | - Yoshitaro Yamamoto
- 2nd Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
| | - Kazuya Ueshima
- 2nd Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine Osaka Medical and Pharmaceutical University Osaka Japan
| |
Collapse
|
4
|
Peroral Cholangioscopy-Guided Targeted Biopsy versus Conventional Endoscopic Transpapillary Forceps Biopsy for Biliary Stricture with Suspected Bile Duct Cancer. J Clin Med 2022; 11:jcm11020289. [PMID: 35053987 PMCID: PMC8779099 DOI: 10.3390/jcm11020289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/29/2021] [Accepted: 01/03/2022] [Indexed: 01/27/2023] Open
Abstract
Background: The recent improvement of peroral cholangioscopy (POCS) maneuverability has enabled the precise, targeted biopsy of bile duct lesions under direct cholangioscopic vision. However, as only small-cup biopsy forceps can pass through the scope channel, the resulting small sample size may limit the pathological diagnosis of biopsy specimens. This study compared the diagnostic abilities of POCS-guided biopsy and conventional fluoroscopy-guided biopsy for bile duct cancer. Method: This multicenter, retrospective cohort study included patients exhibiting bile duct stricture with suspected cholangiocarcinoma in whom POCS-guided and fluoroscopy-guided biopsies were performed in the same session. The primary endpoint was the diagnostic sensitivity for malignancy. The size and quality of the biopsy specimens were also compared. Result: A total of 59 patients were enrolled. The sensitivity of POCS-guided biopsy was similar to that of fluoroscopy-guided biopsy (54.0% and 64.0%, respectively). However, when the modalities were combined, the sensitivity increased to 80.0%. The mean specimen size from POCS-guided biopsy was significantly smaller than that from fluoroscopy-guided biopsy. The specimen quality using fluoroscopy-guided biopsy was also better than that using POCS-guided biopsy. Conclusions: The diagnostic sensitivity of POCS-guided biopsy is still insufficient, mainly because of the limited specimen quantity and quality. Therefore, conventional fluoroscopy-guided biopsy would be helpful to improve diagnostic sensitivity.
Collapse
|
5
|
Lee T, Teng TZJ, Shelat VG. Choledochoscopy: An update. World J Gastrointest Endosc 2021; 13:571-592. [PMID: 35070020 PMCID: PMC8716986 DOI: 10.4253/wjge.v13.i12.571] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/23/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
Choledochoscopy, or cholangioscopy, is an endoscopic procedure for direct visualization within the biliary tract for diagnostic or therapeutic purposes. Since its conception in 1879, many variations and improvements are made to ensure relevance in diagnosing and managing a range of intrahepatic and extrahepatic biliary pathologies. This ranges from improved visual impression and optical guided biopsies of indeterminate biliary strictures and clinically indistinguishable pathologies to therapeutic uses in stone fragmentation and other ablative therapies. Furthermore, with the evolving understanding of biliary disorders, there are significant innovative ideas and techniques to fill this void, such as nuanced instances of biliary stenting and retrieving migrated ductal stents. With this in mind, we present a review of the current advancements in choledo-choscopy with new supporting evidence that further delineates the role of choledochoscopy in various diagnostic and therapeutic interventions, complications, limitations and put forth areas for further study.
Collapse
Affiliation(s)
- Tsinrong Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Thomas Zheng Jie Teng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Vishal G Shelat
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| |
Collapse
|
6
|
Comparison of the Diagnostic Performance of Novel Slim Biopsy Forceps with Conventional Biopsy Forceps for Biliary Stricture: A Multicenter Retrospective Study. J Pers Med 2021; 11:jpm11010055. [PMID: 33477372 PMCID: PMC7830354 DOI: 10.3390/jpm11010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/31/2020] [Accepted: 01/14/2021] [Indexed: 12/04/2022] Open
Abstract
Novel slim biopsy forceps provide some technical advantages to facilitate a more accurate diagnosis, although we are not aware of any comparative studies. Therefore, we compared tissue acquisition and diagnostic accuracy between novel slim biopsy forceps and conventional biopsy forceps in cases with a biliary stricture. We reviewed 341 patients who underwent endoscopic retrograde cholangiopancreatography for the histological confirmation of biliary stricture at two tertiary hospitals between 2013 and 2020. The primary endpoint was the forceps’ diagnostic accuracies. We included 276 patients who underwent biopsy using the novel forceps (n = 130) or conventional forceps (n = 146). The novel forceps provided 81.7% sensitivity, 100.0% specificity, positive-predictive value (PPV) of 100.0%, and negative-predictive value (NPV) of 57.8%, with an accuracy of 85.4% when the diagnosis by endobiliary biopsy included suspected or positive malignancy. The conventional forceps provided 61.7% sensitivity, 100.0% specificity, PPV of 100.0%, and NPV of 36.1%, with an accuracy of 68.5%. Only novel forceps use was significantly associated with an accurate diagnosis (odds ratio: 2.70, 95% confidence interval: 1.52–5.00). There were no significant inter-group differences in the procedure-related rates of adverse events. Endobiliary biopsy using novel forceps offered better diagnostic performance and more acceptable procedure-related adverse events than conventional forceps.
Collapse
|