1
|
Buxbaum J. Diagnosis of indeterminate biliary strictures (with videos). Gastrointest Endosc 2024; 100:296-299. [PMID: 38447663 DOI: 10.1016/j.gie.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Affiliation(s)
- James Buxbaum
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
2
|
Tang RSY. Endoscopic evaluation of indeterminate biliary strictures: Cholangioscopy, endoscopic ultrasound, or both? Dig Endosc 2024; 36:778-788. [PMID: 38014445 DOI: 10.1111/den.14733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/26/2023] [Indexed: 11/29/2023]
Abstract
Accurate and timely diagnosis of biliary strictures can be challenging. Because the diagnostic sensitivity and accuracy of standard endoscopic retrograde cholangiopancreatography-based tissue sampling for malignancy are suboptimal, additional endoscopic evaluation by cholangioscopy and/or endoscopic ultrasound (EUS) is often necessary to differentiate between malignant and benign biliary strictures to guide clinical management. While direct visualization by cholangioscopy and/or high-resolution imaging by EUS are often the first step in the evaluation of an indeterminate biliary stricture (IDBS), tissue diagnosis by cholangioscopy-guided biopsy and/or EUS-guided fine-needle tissue acquisition is the preferred modality to establish a diagnosis of malignancy. Because each modality has its own strengths and limitations, selection of cholangioscopy and EUS is best guided by the biliary stricture location and local expertise. Artificial intelligence-assisted diagnosis, biopsy forceps with improved design, contrast-enhanced EUS, and dedicated fine-needle biopsy devices are recent technological advances that may further improve the diagnostic performance of cholangioscopy and EUS in patients with IDBS.
Collapse
Affiliation(s)
- Raymond S Y Tang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
3
|
Affarah L, Berry P, Kotha S. Still elusive: Developments in the accurate diagnosis of indeterminate biliary strictures. World J Gastrointest Endosc 2024; 16:297-304. [PMID: 38946851 PMCID: PMC11212512 DOI: 10.4253/wjge.v16.i6.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/09/2024] [Accepted: 05/07/2024] [Indexed: 06/13/2024] Open
Abstract
Indeterminate biliary strictures pose a significant diagnostic dilemma for gastroenterologists. Despite advances in endoscopic techniques and instruments, it is difficult to differentiate between benign and malignant pathology. A positive histological diagnosis is always preferred prior to high risk hepatobiliary surgery, or to inform other types of therapy. Endoscopic retrograde cholangiopancreatography with brushings has low sensitivity and despite significant improvements in instruments there is still an unacceptably high false negative rate. Other methods such as endoscopic ultrasound and cholangioscopy have improved diagnostic quality. In this review we explore the techniques available to aid accurate diagnosis of indeterminate biliary strictures and obtain accurate histology to facilitate clinical management.
Collapse
Affiliation(s)
- Lynn Affarah
- Department of Hepatology, Guy's and St Thomas' Hospital, London SE1 7EH, United Kingdom
| | - Philip Berry
- Department of Hepatology, Guy's and St Thomas' Hospital, London SE1 7EH, United Kingdom
| | - Sreelakshmi Kotha
- Department of Hepatology, Guy's and St Thomas' Hospital, London SE1 7EH, United Kingdom
| |
Collapse
|
4
|
Agudo Castillo B, Mascarenhas M, Martins M, Mendes F, de la Iglesia D, Costa AMMPD, Esteban Fernández-Zarza C, González-Haba Ruiz M. Advancements in biliopancreatic endoscopy: a comprehensive review of artificial intelligence in EUS and ERCP. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024. [PMID: 38832589 DOI: 10.17235/reed.2024.10456/2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
The development and implementation of artificial intelligence (AI), particularly deep learning (DL) models, has generated significant interest across various fields of gastroenterology. While research in luminal endoscopy has seen rapid translation to clinical practice with approved AI devices, its potential extends far beyond, offering promising benefits for biliopancreatic endoscopy like optical characterization of strictures during cholangioscopy or detection and classification of pancreatic lesions during diagnostic endoscopic ultrasound (EUS). This narrative review provides an up-to-date of the latest literature and available studies in this field. Serving as a comprehensive guide to the current landscape of AI in biliopancreatic endoscopy, emphasizing technological advancements, main applications, ethical considerations, and future directions for research and clinical implementation.
Collapse
Affiliation(s)
| | | | - Miguel Martins
- Gastroenterology, Centro Hospitalar Universitário de São João
| | - Francisco Mendes
- Gastroenterology, Centro Hospitalar Universitário de São João, Portugal
| | | | | | | | | |
Collapse
|
5
|
Husnain A, Aadam A, Borhani A, Riaz A. Atlas for Cholangioscopy and Cholecystoscopy: A Primer for Diagnostic and Therapeutic Endoscopy in the Biliary Tree and Gallbladder. Semin Intervent Radiol 2024; 41:278-292. [PMID: 39165656 PMCID: PMC11333118 DOI: 10.1055/s-0044-1788340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2024]
Abstract
Percutaneous endoscopy of the biliary system (cholangioscopy) and gallbladder (cholecystoscopy) has significantly impacted diagnostic and therapeutic approaches to many diseases in interventional radiology, overcoming previous challenges related to scope size and rigidity. The current endoscopes offer enhanced maneuverability within narrow tubular structures such as bile ducts. Before endoscopy, reliance on 2D imaging modalities limited real-time visualization during percutaneous procedures. Percutaneous endoscopy provides 3D perspectives, enabling a better appreciation of normal structures, targeted biopsy of lesions, and accurate deployment of therapeutic interventions. This review aims to explore percutaneous endoscopic findings across various biliary and gallbladder pathologies.
Collapse
Affiliation(s)
- Ali Husnain
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Aziz Aadam
- Department of Medicine, Section of Gastroenterology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Amir Borhani
- Department of Radiology, Section of Abdominal Imaging, Northwestern Memorial Hospital, Chicago, Illinois
| | - Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| |
Collapse
|
6
|
Milluzzo SM, Landi R, Perri V, Familiari P, Boškoski I, Pafundi PC, Farina A, Ricci R, Spada C, Costamagna G, Tringali A. Diagnostic accuracy and interobserver agreement of cholangioscopy for indeterminate biliary strictures: A single-center experience. Dig Liver Dis 2024; 56:847-852. [PMID: 38016895 DOI: 10.1016/j.dld.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 09/27/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND AND STUDY AIMS Characterization of indeterminate biliary strictures (IDBS) still represents a major challenge. Digital single-operator cholangioscopy (DSOC) could potentially overcome limits of conventional biopsy and brush sampling. The aim of this study was to compare diagnostic accuracy of visual evaluation and DSOC-guided biopsies to conventional trans-papillary sampling techniques and to evaluate the inter-observer agreement (IOA) on visual diagnosis. PATIENTS AND METHODS All consecutive patients undergoing DSOC-guided biopsy after conventional sampling techniques for IDBS during a six-year period were retrospectively evaluated. Final diagnosis was based on histological evaluation of the surgical specimen if available or a clinical follow-up of at least 6 months. For IOA, 20-second DSOC clips were retrospectively reviewed by 6 experts and 6 trainees and classified according to the Monaco Classification. RESULTS Thirty-five patients underwent DSOC for IDBS in the study period; 14 patients (F = 9) with a median age of 64 years (range 53-76) met the study aim. After DSOC, strictures location was changed in three patients (additional yield of 21.4 %). Intraductal DSOC-guided biopsy were technically successful in all cases, with an adequacy of 92.8 %. No adverse events were recorded. Final diagnosis was benign disease in five cases and cholangiocarcinoma in the others. For IOA, 29 videos were evaluated with almost perfect agreement for final diagnosis (kappa 0.871; agreement 93.1, p <0.001), although overall accuracy of DSOC visual finding was 73.6 % and 64.4 % for experts and trainees, respectively. CONCLUSIONS DSOC could improve diagnostic accuracy for IDBS, since it showed high sensitivity for visual finding and high specificity for DSOC guided-biopsy. Visual diagnosis seems reliable for diagnosis using the Monaco Classification.
Collapse
Affiliation(s)
| | - Rosario Landi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Roma, Lazio, Italy; Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Centre for Endoscopic Research Therapeutics and Training (CERTT), Roma, Lazio, Italy.
| | - Vincenzo Perri
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Roma, Lazio, Italy; Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Centre for Endoscopic Research Therapeutics and Training (CERTT), Roma, Lazio, Italy
| | - Pietro Familiari
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Roma, Lazio, Italy; Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Centre for Endoscopic Research Therapeutics and Training (CERTT), Roma, Lazio, Italy
| | - Ivo Boškoski
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Roma, Lazio, Italy; Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Centre for Endoscopic Research Therapeutics and Training (CERTT), Roma, Lazio, Italy
| | - Pia Clara Pafundi
- Facility of Epidemiology and Biostatistics, Gemelli Generator, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Annarita Farina
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Roma, Lazio, Italy
| | - Riccardo Ricci
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC di Anatomia Patologica, Roma, Lazio, Italy; Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Department of Pathology, Roma, Lazio, Italy
| | - Cristiano Spada
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Roma, Lazio, Italy; Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Centre for Endoscopic Research Therapeutics and Training (CERTT), Roma, Lazio, Italy
| | - Guido Costamagna
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Roma, Lazio, Italy; Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Centre for Endoscopic Research Therapeutics and Training (CERTT), Roma, Lazio, Italy
| | - Andrea Tringali
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Roma, Lazio, Italy; Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Centre for Endoscopic Research Therapeutics and Training (CERTT), Roma, Lazio, Italy
| |
Collapse
|
7
|
Robles-Medranda C, Alcivar-Vasquez J, Raijman I, Kahaleh M, Puga-Tejada M, Del Valle R, Alvarado H, Cifuentes-Gordillo C, Binmoeller KF, Baptista AJ, Barreto-Perez J, Rodriguez J, Egas-Izquierdo M, Cunto D, Calle-Loffredo D, Lukashok H, Baquerizo-Burgos J, Tabacelia D. Accurate and safe diagnosis and treatment of neoplastic biliary lesions using a novel 9F and 11F digital single-operator cholangioscope. Endosc Int Open 2024; 12:E498-E506. [PMID: 38585021 PMCID: PMC10997424 DOI: 10.1055/a-2282-6678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/15/2024] [Indexed: 04/09/2024] Open
Abstract
Background and study aims Digital single-operator cholangioscopy (DSOC) allows the diagnosis of biliary duct disorders and treatment for complicated stones. However, these technologies have limitations such as the size of the probe and working channel, excessive cost, and low image resolution. Recently, a novel DSOC system (eyeMAX, Micro-Tech, Nanjing, China) was developed to address these limitations. We aimed to evaluate the usefulness and safety of a novel 9F and 11F DSOC system in terms of neoplastic diagnostic accuracy based on visual examination, ability to evaluate tumor extension and to achieve complete biliary stone clearance, and procedure-related adverse events (AEs). Patients and methods Data from ≥ 18-year-old patients who underwent DSOC from July 2021 to April 2022 were retrospectively recovered and divided into a diagnostic and a therapeutic cohort. Results A total of 80 patients were included. In the diagnostic cohort (n = 49/80), neovascularity was identified in 26 of 49 patients (46.9%). Biopsy was performed in 65.3% patients with adequate tissue sample obtained in 96.8% of cases. Biopsy confirmed neoplasia in 23 of 32 cases. DSOC visual impression achieved 91.6% sensitivity and 87.5% specificity in diagnosing neoplasms. In the therapeutic cohort (n = 43/80), 26 of 43 patients required lithotripsy alone. Total stone removal was achieved in 71% patients in the first session. Neither early nor late AEs were documented in either the diagnostic or therapeutic cohort. Conclusions The novel DSOC device has excellent diagnostic accuracy in distinguishing neoplastic biliary lesions as well as therapeutic benefits in the context of total stone removal, with no documented AEs.
Collapse
Affiliation(s)
- Carlos Robles-Medranda
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Juan Alcivar-Vasquez
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Isaac Raijman
- Gastroenterology, Digestive Associates of Houston, Houston, United States
| | - Michel Kahaleh
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, United States
| | - Miguel Puga-Tejada
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Raquel Del Valle
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Haydee Alvarado
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | | | | | | | - Jonathan Barreto-Perez
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Jorge Rodriguez
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Maria Egas-Izquierdo
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Domenica Cunto
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Daniel Calle-Loffredo
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Hannah Lukashok
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Jorge Baquerizo-Burgos
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Daniela Tabacelia
- Gastroenterology, Elias Emergency University Hospital, Bucuresti, Romania
- Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania
| |
Collapse
|
8
|
Zhang W, Chai N, Wu Q, Linghu E. The new criteria for differential diagnosis of indeterminate biliary stricture under super minimally invasive peroral cholangioscopy. Chin Med J (Engl) 2024; 137:255-256. [PMID: 37612253 PMCID: PMC10836894 DOI: 10.1097/cm9.0000000000002827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Indexed: 08/25/2023] Open
Affiliation(s)
| | | | | | - Enqiang Linghu
- Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China
| |
Collapse
|
9
|
Rey Rubiano AM, González-Teshima LY, Arango L, Blanco-Avellaneda C, Carvajal Gutiérrez JJ, Castaño-Llano R, Gómez Zuleta MA, González C, Peñaloza-Ramírez A, Pinilla Morales R, Pinto Carta R, Polanía Liscano HA, Rincón Sánchez RA, Sepúlveda Copete M, Vargas-Rubio R, Avendaño Capriles CA, García-Sierra AM, Yepes-Nuñez JJ. Clinical practice guideline on the use of single-operator cholangioscopy in the diagnosis of indeterminate biliary stricture and the treatment of difficult biliary stones. Surg Endosc 2024; 38:499-510. [PMID: 38148404 PMCID: PMC10830582 DOI: 10.1007/s00464-023-10569-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 10/23/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND AND AIMS Single-operator cholangioscopy (SOC) offer a diagnostic and therapeutic alternative with an improved optical resolution over conventional techniques; however, there are no standardized clinical practice guidelines for this technology. This evidence-based guideline from the Colombian Association of Digestive Endoscopy (ACED) intends to support patients, clinicians, and others in decisions about using in adults the SOC compared to endoscopic retrograde cholangiopancreatography (ERCP), to diagnose indeterminate biliary stricture and to manage difficult biliary stones. METHODS ACED created a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. Universidad de los Andes and the Colombia Grading of Recommendations Assessment, Development and Evaluation (GRADE) Network supported the guideline-development process, updating and performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The GRADE approach was used, including GRADE Evidence-to-Decision frameworks. RESULTS The panel agreed on one recommendation for adult patients with indeterminate biliary strictures and one for adult patients with difficult biliary stones when comparing SOC versus ERCP. CONCLUSION For adult patients with indeterminate biliary strictures, the panel made a conditional recommendation for SOC with stricture pattern characterization over ERCP with brushing and/or biopsy for sensitivity, specificity, and procedure success rate outcomes. For the adult patients with difficult biliary stones the panel made conditional recommendation for SOC over ERCP with large-balloon dilation of papilla. Additional research is required on economic estimations of SOC and knowledge translation evaluations to implement SOC intervention in local contexts.
Collapse
Affiliation(s)
- Adriana Margarita Rey Rubiano
- School of Medicine, Universidad de los Andes, Carrera 1 # 18a-12, Bogotá, D.C., Colombia
- Department of Gastroenterology, Fundación Santa Fe de Bogotá, Bogotá, D.C., Colombia
| | | | - Lázaro Arango
- Department of Clinical Surgical Gastroenterology, University of Caldas, Manizales, Caldas, Colombia.
- Department of Endoscopy and Gastroenterology, University of Caldas, Manizales, Caldas, Colombia.
- Union of surgeons, Zentria Group, Manizales, Caldas, Colombia.
| | - Camilo Blanco-Avellaneda
- Department of Gastrointestinal Surgery and Digestive Endoscopy, Pontificia Universidad Javeriana, Bogotá, D.C, Colombia
- Education and Research Group, Faculty of Education, Universidad El Bosque, Bogotá, D.C., Colombia
- Videoendoscopy Unit of Restrepo Ltda, Bogotá, D.C, Colombia
| | - Jhon Jaime Carvajal Gutiérrez
- Department of Gastroenterology, Hospital Pablo Tobón Uribe, Medellín, Antioquia, Colombia
- Department of Internal Medicine, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Rodrigo Castaño-Llano
- Department of Gastroenterology, Universidad de Antioquia, Medellín, Antioquia, Colombia
- Institute of Cancerology, Clínica las Américas Auna, Medellín, Antioquia, Colombia
| | - Martin Alonso Gómez Zuleta
- Department of Internal Medicine, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
- Department of Internal Medicine, Gastroenterology Section, Hospital Universitario Nacional de Colombia, Bogotá, D.C., Colombia
| | - Carlos González
- Department of Gastroenterology and Digestive Endoscopy, Clínica Reina Sofia, Bogotá, D.C., Colombia
- Department of Gastroenterology and Digestive Endoscopy, Fundación Universitaria Sanitas, Bogotá, D.C., Colombia
- Department of Gastroenterology, Clínica Colombia, Bogotá, D.C., Colombia
| | - Arecio Peñaloza-Ramírez
- Department of Gastroenterology, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C., Colombia
- Department of Gastroenterology, Hospital de San José, Bogotá, D.C., Colombia
| | - Raúl Pinilla Morales
- Department of Gastroenterology and Oncological Digestive Endoscopy, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia
- School of Medicine, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
| | - Renzo Pinto Carta
- Colombian Association of Digestive Endoscopy, Bogotá, D.C., Colombia
- American Society for Gastrointestinal Endoscopy, Rochester, USA
| | - Héctor Adolfo Polanía Liscano
- Department of Gastroenterology, Universidad Surcolombiana, Neiva, Huila, Colombia
- Endotek Ltda, Hospital Universitario Neiva, Neiva, Huila, Colombia
| | - Reinaldo Andrés Rincón Sánchez
- Department of Internal Medicine and Gastroenterology, Pontificia Universidad Javeriana - Hospital Universitario San Ignacio, Bogotá, D.C., Colombia
- Department of Gastroenterology, Fundación Clínica Shaio, Bogotá, D.C., Colombia
| | | | - Rómulo Vargas-Rubio
- Department of Gastroenterology, Hospital Universitario de San Ignacio, Pontificia Universidad Javeriana, Bogotá, D.C., Colombia
| | - Camilo Andrés Avendaño Capriles
- School of Medicine, Universidad del Norte, Barranquilla, Colombia
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Andrés Mauricio García-Sierra
- School of Medicine, Universidad de los Andes, Carrera 1 # 18a-12, Bogotá, D.C., Colombia
- School of Global Health Management and Informatics, University of Central Florida, Orlando, USA
| | - Juan José Yepes-Nuñez
- School of Medicine, Universidad de los Andes, Carrera 1 # 18a-12, Bogotá, D.C., Colombia.
- Pulmonology Service, Internal Medicine Section, Fundación Santa Fe de Bogotá University Hospital, Bogotá, D.C., Colombia.
- Colombia GRADE Network, Bogotá, D.C., Colombia.
| |
Collapse
|
10
|
Saraiva MM, Ribeiro T, González-Haba M, Agudo Castillo B, Ferreira JPS, Vilas Boas F, Afonso J, Mendes F, Martins M, Cardoso P, Pereira P, Macedo G. Deep Learning for Automatic Diagnosis and Morphologic Characterization of Malignant Biliary Strictures Using Digital Cholangioscopy: A Multicentric Study. Cancers (Basel) 2023; 15:4827. [PMID: 37835521 PMCID: PMC10571941 DOI: 10.3390/cancers15194827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
Digital single-operator cholangioscopy (D-SOC) has enhanced the ability to diagnose indeterminate biliary strictures (BSs). Pilot studies using artificial intelligence (AI) models in D-SOC demonstrated promising results. Our group aimed to develop a convolutional neural network (CNN) for the identification and morphological characterization of malignant BSs in D-SOC. A total of 84,994 images from 129 D-SOC exams in two centers (Portugal and Spain) were used for developing the CNN. Each image was categorized as either a normal/benign finding or as malignant lesion (the latter dependent on histopathological results). Additionally, the CNN was evaluated for the detection of morphologic features, including tumor vessels and papillary projections. The complete dataset was divided into training and validation datasets. The model was evaluated through its sensitivity, specificity, positive and negative predictive values, accuracy and area under the receiver-operating characteristic and precision-recall curves (AUROC and AUPRC, respectively). The model achieved a 82.9% overall accuracy, 83.5% sensitivity and 82.4% specificity, with an AUROC and AUPRC of 0.92 and 0.93, respectively. The developed CNN successfully distinguished benign findings from malignant BSs. The development and application of AI tools to D-SOC has the potential to significantly augment the diagnostic yield of this exam for identifying malignant strictures.
Collapse
Affiliation(s)
- Miguel Mascarenhas Saraiva
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Tiago Ribeiro
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Mariano González-Haba
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro Majadahonda, C/Joaquín Rodrigo, 28220 Majadahonda, Madrid, Spain
| | - Belén Agudo Castillo
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro Majadahonda, C/Joaquín Rodrigo, 28220 Majadahonda, Madrid, Spain
| | - João P. S. Ferreira
- Department of Mechanical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
- DigestAID—Digestive Artificial Intelligence Development, Rua Alfredo Allen n.º 455/461, 4200-135 Porto, Portugal
| | - Filipe Vilas Boas
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - João Afonso
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Francisco Mendes
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Miguel Martins
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Pedro Cardoso
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Pedro Pereira
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| |
Collapse
|
11
|
Yadlapati S, Mulki R, Sánchez-Luna SA, Ahmed AM, Kyanam Kabir Baig KR, Peter S. Clinical approach to indeterminate biliary strictures: Clinical presentation, diagnosis, and workup. World J Gastroenterol 2023; 29:5198-5210. [PMID: 37901449 PMCID: PMC10600956 DOI: 10.3748/wjg.v29.i36.5198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/23/2023] [Accepted: 08/21/2023] [Indexed: 09/20/2023] Open
Abstract
Despite advances in cross-sectional imaging and endoscopic technology, bile duct strictures remain a challenging clinical entity. It is crucial to make an early determination of benign or malignant nature of biliary strictures. Early diagnosis not only helps with further management but also minimizes mortality and morbidity associated with delayed diagnosis. Conventional imaging and endoscopic techniques, particularly endoscopic retrograde cholangiopancreatography (ERCP) and tissue sampling techniques play a key in establishing a diagnosis. Indeterminate biliary strictures (IDBSs) have no definite mass on imaging or absolute histopathological diagnosis and often warrant utilization of multiple diagnostics to ascertain an etiology. In this review, we discuss possible etiologies, clinical presentation, diagnosis, and management of IDBSs. Based on available data and expert opinion, we depict an evidence based diagnostic algorithm for management of IDBSs. Areas of focus include use of traditional tissue sampling techniques such as ERCP with brush cytology, intraductal biopsies, fluorescence in situ hybridization and flow cytometry. We also describe the role of endoscopic ultrasound (EUS)-guided fine needle aspiration and biopsies, cholangioscopy, confocal laser endomicroscopy, and intraductal EUS in management of IDBSs.
Collapse
Affiliation(s)
- Sujani Yadlapati
- Department of Gastroenterology and Hepatology, Indiana University Hospital, Indianapolis, IN 46202, USA
| | - Ramzi Mulki
- Department of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Sergio A Sánchez-Luna
- Department of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Ali M Ahmed
- Department of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | | | - Shajan Peter
- Department of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| |
Collapse
|
12
|
Mauro A, Mazza S, Scalvini D, Lusetti F, Bardone M, Quaretti P, Cobianchi L, Anderloni A. The Role of Cholangioscopy in Biliary Diseases. Diagnostics (Basel) 2023; 13:2933. [PMID: 37761300 PMCID: PMC10528268 DOI: 10.3390/diagnostics13182933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 09/29/2023] Open
Abstract
Endoscopy plays a central role in diagnostic and therapeutic approaches to biliary disease in both benign and malignant conditions. A cholangioscope is an endoscopic instrument that allows for the direct exploration of the biliary tree. Over the years, technology has improved endoscopic image quality and allowed for the development of an operative procedure that can be performed during cholangioscopy. Different types of instruments are available in this context, and they can be used in different anatomical access points according to the most appropriate clinical indication. The direct visualization of biliary mucosa is essential in the presence of biliary strictures of unknown significance, allowing for the appropriate allocation of patients to surgery or conservative treatments. Cholangioscopy has demonstrated excellent performance in discriminating malignant conditions (such as colangiocarcinoma) from benign inflammatory strictures, and more recent advances (e.g., artificial intelligence and confocal laser endomicroscopy) could further increase its diagnostic accuracy. Cholangioscopy also plays a primary role in the treatment of benign conditions such as difficult bile stones (DBSs). In this case, it may not be possible to achieve complete biliary drainage using standard ERCP. Therapeutic cholangioscopy-guided lithotripsy allows for stone fragmentation and complete biliary drainage. Indeed, other complex clinical situations, such as patients with intra-hepatic lithiasis and patients with an altered anatomy, could benefit from the therapeutic role of cholangioscopy. The aim of the present review is to explore the most recent diagnostic and therapeutic advances in the roles of cholangioscopy in the management of biliary diseases.
Collapse
Affiliation(s)
- Aurelio Mauro
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
| | - Stefano Mazza
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
| | - Davide Scalvini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Francesca Lusetti
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Marco Bardone
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
| | - Pietro Quaretti
- Unit of Interventional Radiology, Department of Radiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Lorenzo Cobianchi
- Department of General Surgery, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Andrea Anderloni
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
| |
Collapse
|
13
|
Zhang X, Tang D, Zhou JD, Ni M, Yan P, Zhang Z, Yu T, Zhan Q, Shen Y, Zhou L, Zheng R, Zou X, Zhang B, Li WJ, Wang L. A real-time interpretable artificial intelligence model for the cholangioscopic diagnosis of malignant biliary stricture (with videos). Gastrointest Endosc 2023; 98:199-210.e10. [PMID: 36849057 DOI: 10.1016/j.gie.2023.02.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/22/2023] [Accepted: 02/20/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND AND AIMS It is crucial to accurately determine malignant biliary strictures (MBSs) for early curative treatment. This study aimed to develop a real-time interpretable artificial intelligence (AI) system to predict MBSs under digital single-operator cholangioscopy (DSOC). METHODS A novel interpretable AI system called MBSDeiT was developed consisting of 2 models to identify qualified images and then predict MBSs in real time. The overall efficiency of MBSDeiT was validated at the image level on internal, external, and prospective testing data sets and subgroup analyses, and at the video level on the prospective data sets; these findings were compared with those of the endoscopists. The association between AI predictions and endoscopic features was evaluated to increase the interpretability. RESULTS MBSDeiT can first automatically select qualified DSOC images with an area under the curve (AUC) of .963 and .968 to .973 on the internal testing data set and the external testing data sets, and then identify MBSs with an AUC of .971 on the internal testing data set, an AUC of .978 to .999 on the external testing data sets, and an AUC of .976 on the prospective testing data set, respectively. MBSDeiT accurately identified 92.3% of MBSs in prospective testing videos. Subgroup analyses confirmed the stability and robustness of MBSDeiT. The AI system achieved superior performance to that of expert and novice endoscopists. The AI predictions were significantly associated with 4 endoscopic features (nodular mass, friability, raised intraductal lesion, and abnormal vessels; P < .05) under DSOC, which is consistent with the endoscopists' predictions. CONCLUSIONS The study findings suggest that MBSDeiT could be a promising approach for the accurate diagnosis of MBSs under DSOC.
Collapse
Affiliation(s)
- Xiang Zhang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Dehua Tang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Jin-Dong Zhou
- National Institute of Healthcare Data Science at Nanjing University, Nanjing, Jiangsu, China; National Key Laboratory for Novel Software Technology, Department of Computer Science and Technology, Nanjing University, Nanjing, Jiangsu, China
| | - Muhan Ni
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Peng Yan
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Zhenyu Zhang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Tao Yu
- Departments of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Qiang Zhan
- Department of Gastroenterology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Yonghua Shen
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Lin Zhou
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Ruhua Zheng
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Xiaoping Zou
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China; Department of Gastroenterology, Taikang Xianlin Drum Tower Hospital, Nanjing, Jiangsu, China
| | - Bin Zhang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.
| | - Wu-Jun Li
- National Institute of Healthcare Data Science at Nanjing University, Nanjing, Jiangsu, China; National Key Laboratory for Novel Software Technology, Department of Computer Science and Technology, Nanjing University, Nanjing, Jiangsu, China; Center for Medical Big Data, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.
| | - Lei Wang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.
| |
Collapse
|
14
|
Robles-Medranda C, Baquerizo-Burgos J, Alcivar-Vasquez J, Kahaleh M, Raijman I, Kunda R, Puga-Tejada M, Egas-Izquierdo M, Arevalo-Mora M, Mendez JC, Tyberg A, Sarkar A, Shahid H, del Valle-Zavala R, Rodriguez J, Merfea RC, Barreto-Perez J, Saldaña-Pazmiño G, Calle-Loffredo D, Alvarado H, Lukashok HP. Artificial intelligence for diagnosing neoplasia on digital cholangioscopy: development and multicenter validation of a convolutional neural network model. Endoscopy 2023; 55:719-727. [PMID: 36781156 PMCID: PMC10374349 DOI: 10.1055/a-2034-3803] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 02/13/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND We aimed to develop a convolutional neural network (CNN) model for detecting neoplastic lesions during real-time digital single-operator cholangioscopy (DSOC) and to clinically validate the model through comparisons with DSOC expert and nonexpert endoscopists. METHODS In this two-stage study, we first developed and validated CNN1. Then, we performed a multicenter diagnostic trial to compare four DSOC experts and nonexperts against an improved model (CNN2). Lesions were classified into neoplastic and non-neoplastic in accordance with Carlos Robles-Medranda (CRM) and Mendoza disaggregated criteria. The final diagnosis of neoplasia was based on histopathology and 12-month follow-up outcomes. RESULTS In stage I, CNN2 achieved a mean average precision of 0.88, an intersection over the union value of 83.24 %, and a total loss of 0.0975. For clinical validation, a total of 170 videos from newly included patients were analyzed with the CNN2. Half of cases (50 %) had neoplastic lesions. This model achieved significant accuracy values for neoplastic diagnosis, with a 90.5 % sensitivity, 68.2 % specificity, and 74.0 % and 87.8 % positive and negative predictive values, respectively. The CNN2 model outperformed nonexpert #2 (area under the receiver operating characteristic curve [AUC]-CRM 0.657 vs. AUC-CNN2 0.794, P < 0.05; AUC-Mendoza 0.582 vs. AUC-CNN2 0.794, P < 0.05), nonexpert #4 (AUC-CRM 0.683 vs. AUC-CNN2 0.791, P < 0.05), and expert #4 (AUC-CRM 0.755 vs. AUC-CNN2 0.848, P < 0.05; AUC-Mendoza 0.753 vs. AUC-CNN2 0.848, P < 0.05). CONCLUSIONS The proposed CNN model distinguished neoplastic bile duct lesions with good accuracy and outperformed two nonexpert and one expert endoscopist.
Collapse
Affiliation(s)
- Carlos Robles-Medranda
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Jorge Baquerizo-Burgos
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Juan Alcivar-Vasquez
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Michel Kahaleh
- Gastroenterology, Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, United States
| | - Isaac Raijman
- Houston Methodist Hospital, Houston, Texas, United States
- Baylor Saint Luke’s Medical Center, Houston, Texas, United States
| | - Rastislav Kunda
- Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel (UZB)/Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Miguel Puga-Tejada
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Maria Egas-Izquierdo
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Martha Arevalo-Mora
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Juan C. Mendez
- mdconsgroup, Artificial Intelligence Department, Guayaquil, Ecuador
| | - Amy Tyberg
- Gastroenterology, Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, United States
| | - Avik Sarkar
- Gastroenterology, Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, United States
| | - Haroon Shahid
- Gastroenterology, Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, United States
| | - Raquel del Valle-Zavala
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Jorge Rodriguez
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Ruxandra C. Merfea
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Jonathan Barreto-Perez
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | | | - Daniel Calle-Loffredo
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Haydee Alvarado
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Hannah P. Lukashok
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| |
Collapse
|
15
|
Abstract
PURPOSE OF REVIEW Cholangioscopy is a mini-invasive endoscopic procedure, which consists in a direct intraductal visualization of the biliary tract. The purpose of this review is to summarize the technique, the clinical applications, as well as future perspectives of cholangioscopy. RECENT FINDINGS Numerous technologic advances during the last decades have allowed for an improved utility and functionality, leading to a broader use of this procedure, for diagnostic or therapeutic purposes, in the setting of biliary diseases. Novel tools and emerging indications have been developed and more are yet to come. SUMMARY Cholangioscopy can be performed by peroral, percutaneous transhepatic or intra-operative transcystic or transcholedochal access. Clinical applications of cholangioscopy are multiple, ranging from visual impression and optical guided biopsies of indeterminate biliary strictures to the management of difficult stones , guidance before biliary stenting and retrieval of migrated ductal stents. Multiple devices such as lithotripsy probes, biopsy forceps, snares and baskets have been developed to help achieve these procedures successfully.Cholangioscopy has improved the way biliary diseases can be visualized and treated. New technology, accessories, and applications are expected in the future.
Collapse
|
16
|
Endoscopic Evaluation and Management of Cholangiocarcinoma. Gastroenterol Clin North Am 2022; 51:519-535. [PMID: 36153108 DOI: 10.1016/j.gtc.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Cholangiocarcinoma is a rare malignancy of the biliary tract with a relatively poor prognosis. As a gastroenterologist, our main role is to differentiate between benign and malignant biliary disease, help achieve a diagnosis, and palliate jaundice related to biliary obstruction. This article focuses on summarizing the various tools currently available for endoscopic evaluation and management of cholangiocarcinoma.
Collapse
|
17
|
Tyberg A, Raijman I, Gaidhane M, Trindade AJ, Shahid H, Sarkar A, Samarasena J, Andalib I, Diehl DL, Pleskow DK, Woods KE, Gordon SR, Pannala R, Kedia P, Draganov PV, Tarnasky PR, Sejpal DV, Kumta NA, Parasher G, Adler DG, Patel K, Yang D, Siddiqui U, Kahaleh M, Joshi V. First interobserver agreement of optical coherence tomography in the bile duct: A multicenter collaborative study. Endosc Int Open 2022; 10:E1065-E1072. [PMID: 35979031 PMCID: PMC9377829 DOI: 10.1055/a-1779-5027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background and study aims Optical coherence tomography (OCT) is a new technology available for evaluation of indeterminate biliary strictures. It allows under-the-surface visualization and preliminary studies have confirmed standardized characteristics associated with malignancy. The aim of this study is to evaluate the first interobserver agreement in identifying previously agreed upon OCT criteria and diagnosing of malignant versus benign disease. Patients and methods Fourteen endoscopists were asked to review an atlas of reference clips and images of eight criteria derived from expert consensus A total of 35 de-identified video clips were then evaluated for presence of the eight criteria and for final diagnosis of malignant versus benign using the atlas as reference Intraclass correlation (ICC) analysis was done to evaluate interrater agreement. Results Clips of 23 malignant lesions and 12 benign lesions were scored. Excellent interobserver agreement was seen with dilated hypo-reflective structures (0.85) and layering effacement (0.89); hyper-glandular mucosa (0.76), intact layering (0.81), and onion-skin layering (0.77); fair agreement was seen with scalloping (0.58), and thickened epithelium (0.4); poor agreement was seen with hyper-reflective surface (0.36). The diagnostic ICC for both neoplastic (0.8) and non-neoplastic (0.8) was excellent interobserver agreement. The overall diagnostic accuracy was 51 %, ranging from 43 % to 60 %. Conclusions Biliary OCT is a promising new modality for evaluation of indeterminate biliary strictures. Interobserver agreement ranged from fair to almost perfect on eight previously identified criteria. Interobserver agreement for malignancy diagnosis was substantial (0.8). Further studies are needed to validate this data.
Collapse
Affiliation(s)
- Amy Tyberg
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| | - Isaac Raijman
- Baylor St Lukes Medical Center, Houston, Texas, United States
| | - Monica Gaidhane
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| | - Arvind J. Trindade
- Long Island Jewish Medical Center, New Hyde Park, New York, United States
| | - Haroon Shahid
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| | - Avik Sarkar
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| | - Jason Samarasena
- University of California Irvine, Irvine, California, United States
| | - Iman Andalib
- Mount Sinai South Nassau, Oceanside, New York, United States
| | - David L. Diehl
- Geisinger Medical Center, Danville, Pennsylvania, United States
| | - Douglas K. Pleskow
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Kevin E. Woods
- Southeastern Regional Medical Center, Lumberton, North Carolina, United States
| | - Stuart R. Gordon
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
| | - Rahul Pannala
- Mayo Clinic Phoenix, Phoenix, Arizona, United States
| | - Prashant Kedia
- Methodist Dallas Medical Center, Dallas, Texas, United States
| | - Peter V. Draganov
- University of Florida, Gainesville, Gainesville, Florida, United States
| | | | | | | | - Gulshan Parasher
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States
| | - Douglas G. Adler
- University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Kalpesh Patel
- Baylor College of Medicine, Houston, Texas, United States
| | - Dennis Yang
- University of Florida, Gainesville, Gainesville, Florida, United States
| | - Uzma Siddiqui
- University of Chicago, Chicago, Illinois, United States
| | - Michel Kahaleh
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| | - Viren Joshi
- Ochsner Medical Center, New Orleans, Louisiana, United States
| |
Collapse
|
18
|
Nabi Z, Reddy DN. Multidisciplinary Approach to Indeterminate Biliary Strictures. Gastrointest Endosc Clin N Am 2022; 32:411-425. [PMID: 35691689 DOI: 10.1016/j.giec.2022.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Biliary strictures that remain unclassified after cross-sectional imaging and endoscopic retrograde cholangiopancreatography-based tissue sampling are defined as indeterminate biliary strictures (IDBS). A substantial proportion of biliary strictures fall into this category due to low sensitivity of brush cytology and intraductal biopsy. Over last few decades, several modalities have emerged for the evaluation of IDBS. Of these, cholangioscopy and endosonography are the frontrunners and have cemented their place for the evaluation of IDBS. Both of these modalities are widely available, and therefore, biliary strictures that remain uncharacterized after their utilization represent IDBS in the current era.
Collapse
Affiliation(s)
- Zaheer Nabi
- Asian Institute of Gastroenterology & AIG Hospitals, Mind Space Road, Gachibowli, Hyderabad 500 032 India
| | - D Nageshwar Reddy
- Asian Institute of Gastroenterology & AIG Hospitals, Mind Space Road, Gachibowli, Hyderabad 500 032 India.
| |
Collapse
|
19
|
Abstract
Bile duct stenosis continues to present a diagnostic dilemma for clinicians. It is important to establish the benign or malignant nature of the stricture early in order to avoid any unnecessary delay in medical treatment or surgery. Tissue acquisition for histological diagnosis is particularly crucial when the initial diagnostic work up is inconclusive. The diagnostic yield from the conventional endoscopic retrograde cholangiopancreatography (ERCP) with brushing and biopsy is suboptimal. Patients with indeterminate biliary strictures (IDBSs) often require a multi-disciplinary diagnostic approach and additional endoscopic evaluation, including cholangioscopy and endoscopic ultrasound, before a final diagnosis can be reached. In this article, we discuss the recent endoscopic advancements in the diagnosis of biliary stricture with a focus on the roles of cholangioscopy and endoscopic ultrasound (EUS).
Collapse
|