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Papaefthymiou A, Gkolfakis P, Basiliya K, Facciorusso A, Ramai D, Gerges C, Tziatzios G, Phillpotts S, Webster GJ. Performance and safety of percutaneous cholangioscopy: a systematic review and meta-analysis. Ann Gastroenterol 2024; 37:225-234. [PMID: 38481781 PMCID: PMC10927623 DOI: 10.20524/aog.2024.0869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/27/2023] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Percutaneous cholangioscopy (PerC) offers an alternative for patients with an inaccessible biliary tree. This systematic review and meta-analysis aimed to evaluate the performance of this technique. METHODS A search in Medline, Cochrane and ClinicalTrials.gov databases was performed for studies assessing PerC up to October 2022. The primary outcome was diagnostic success, defined as successful stone identification or stricture workup. Secondary outcomes included therapeutic success (stone extraction, stenting) and complication rate. A subgroup analysis compared previous-generation and modern cholangioscopes. We performed meta-analyses using a random-effects model and the results were reported as percentages with 95% confidence interval (CI). RESULTS Fourteen studies (682 patients) were eligible for analysis. The rate of diagnostic success was 98.7% (95%CI 97.6-99.8%; I2=31.19%) and therapeutic success was 88.6% (95%CI 82.8-94.3%; I2=74.92%). Adverse events were recorded in 17.1% (95%CI 10.7-23.5%; I2=77.56%), of which 15.9% (95%CI 9.8-21.9%; I2=75.98%) were minor and 0.6% (95%CI 0.1-1.2%; I2=0%) major. The Spyglass system showed null heterogeneity for all outcomes; compared with older-generation endoscopes it offered comparable diagnostic success, but yielded significantly superior therapeutic success (96.1%, 95%CI 90-100%; I2=0% vs. 86.4%, 95%CI 79.2-93.6%; I2=81.41%; P=0.02]. CONCLUSION PerC, especially using currently available cholangioscopes, is associated with high diagnostic and therapeutic success.
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Affiliation(s)
- Apostolis Papaefthymiou
- Pancreaticobiliary Medicine Unit, University College London Hospitals (UCLH), London, United Kingdom (Apostolis Papaefthymiou, Kirill Basiliya, Simon Phillpotts, George J. Webster)
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, “Konstantopoulio-Patision” General Hospital of Nea Ionia, Athens, Greece (Paraskevas Gkolfakis Georgios Tziatzios)
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, ULB, Brussels, Belgium (Paraskevas Gkolfakis)
| | - Kirill Basiliya
- Pancreaticobiliary Medicine Unit, University College London Hospitals (UCLH), London, United Kingdom (Apostolis Papaefthymiou, Kirill Basiliya, Simon Phillpotts, George J. Webster)
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy (Antonio Facciorusso)
| | - Daryl Ramai
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT, USA (Daryl Ramai)
| | - Christian Gerges
- Department of Gastroenterology, University Hospital Essen, Essen, Germany (Christian Gerges)
| | - Georgios Tziatzios
- Department of Gastroenterology, “Konstantopoulio-Patision” General Hospital of Nea Ionia, Athens, Greece (Paraskevas Gkolfakis Georgios Tziatzios)
| | - Simon Phillpotts
- Pancreaticobiliary Medicine Unit, University College London Hospitals (UCLH), London, United Kingdom (Apostolis Papaefthymiou, Kirill Basiliya, Simon Phillpotts, George J. Webster)
| | - George J. Webster
- Pancreaticobiliary Medicine Unit, University College London Hospitals (UCLH), London, United Kingdom (Apostolis Papaefthymiou, Kirill Basiliya, Simon Phillpotts, George J. Webster)
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