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Turowski F, Hügle U, Dormann A, Bechtler M, Jakobs R, Gottschalk U, Nötzel E, Hartmann D, Lorenz A, Kolligs F, Veltzke-Schlieker W, Adler A, Becker O, Wiedenmann B, Bürgel N, Tröger H, Schumann M, Daum S, Siegmund B, Bojarski C. Diagnostic and therapeutic single-operator cholangiopancreatoscopy with SpyGlassDS™: results of a multicenter retrospective cohort study. Surg Endosc 2018. [PMID: 29532224 DOI: 10.1007/s00464-018-6141-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS The aim of the study was to evaluate the usefulness and diagnostic and therapeutic outcome of the single-operator cholangiopancreatoscopy (SOC) with SpyGlassDS™. METHODS In a retrospective multicenter study between November 2015 and January 2017, SpyGlassDS™ procedures were analyzed in participating centers. Indications, accuracy of SOC-guided biopsies, management of large bile duct stones, and complications were analyzed. Follow-up was 4 months. RESULTS Two hundred and six patients out of 250 examinations were evaluated. Indications were biliary stones (n = 132), bile duct stenosis (n = 93), stones and stenosis combined (n = 24), and bile duct leakage (n = 1). Of the 117 cases which were suspicious of malignancy, in 99 cases the lesion could be stratified into benign (n = 55) or malignant (n = 44) indicating a sensitivity of 95.5% and a specificity of 94.5% for the indication tumor. SOC-guided biopsies revealed a sensitivity of 57.7% with a specificity of 100%. In 107 examinations, biliary stones were visualized and could be completely removed in 91.1% with a need of three procedures (range 1-6) to achieve final stone clearance. In 75 cases, lithotripsy was performed and was successful in 71 cases (95%). Four out of 45 patients (8.9%) underwent cholecystectomy with surgical bile duct revision as a final therapy. Adverse Event (AE) occurred in 33/250 patients (13.2%) and Serious Adverse Event (SAE) occurred in 1/250 patients (0.4%). Cholangitis was 1% (n = 102) after peri-interventional administration of antibiotics and 12.8% (n = 148) without antibiotic prophylaxis (p < 0.001). CONCLUSIONS SOC with SpyGlassDS™ became a new standard for the diagnosis of indefinite biliary lesions and therapy of large bile duct stones. The diagnostic yield of SOC-guided biopsies facilitated a definite diagnosis in most cases and should be improved by standardized biopsy protocols. SOC-guided interventions allowed removal of large biliary stones by SOC-guided lithotripsy. The complication rate of 13.2% can be considerably reduced by use of a single-shot antibiotic treatment.
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Affiliation(s)
- Felicia Turowski
- Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Ulrich Hügle
- Krankenhaus Holweide, Medizinische Klinik, Kliniken der Stadt Köln, 51058, Cologne, Germany
| | - Arno Dormann
- Krankenhaus Holweide, Medizinische Klinik, Kliniken der Stadt Köln, 51058, Cologne, Germany
| | - Matthias Bechtler
- Medizinische Klinik C, Klinikum Ludwigshafen, Bremser Str. 79, 67063, Ludwigshafen, Germany
| | - Ralf Jakobs
- Medizinische Klinik C, Klinikum Ludwigshafen, Bremser Str. 79, 67063, Ludwigshafen, Germany
| | - Uwe Gottschalk
- Klinik für Innere Medizin I, Dietrich Bonhoeffer Klinikum, Salvador-Allende-Str. 30, 17036, Neubrandenburg, Germany
| | - Ellen Nötzel
- Innere Medizin I: Schwerpunkt Gastroenterologie, Sana Klinikum Lichtenberg, Fanningerstr. 32, 10365, Berlin, Germany
| | - Dirk Hartmann
- Innere Medizin I: Schwerpunkt Gastroenterologie, Sana Klinikum Lichtenberg, Fanningerstr. 32, 10365, Berlin, Germany
| | - Albrecht Lorenz
- Klinik für Allgemeine Innere Medizin und Gastroenterologie, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | - Frank Kolligs
- Klinik für Allgemeine Innere Medizin und Gastroenterologie, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | - Wilfried Veltzke-Schlieker
- Medizinische Klinik mit Schwerpunkt Gastroenterologie und Hepatologie, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Andreas Adler
- Medizinische Klinik mit Schwerpunkt Gastroenterologie und Hepatologie, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Olaf Becker
- Medizinische Klinik mit Schwerpunkt Gastroenterologie und Hepatologie, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bertram Wiedenmann
- Medizinische Klinik mit Schwerpunkt Gastroenterologie und Hepatologie, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Nataly Bürgel
- Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Hanno Tröger
- Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Michael Schumann
- Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Severin Daum
- Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Britta Siegmund
- Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Christian Bojarski
- Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
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Klare P, Haller B, Wormbt S, Nötzel E, Hartmann D, Albert J, Hausmann J, Einwächter H, Weber A, Abdelhafez M, Schmid RM, von Delius S. Narrow-band imaging vs. high definition white light for optical diagnosis of small colorectal polyps: a randomized multicenter trial. Endoscopy 2016; 48:909-15. [PMID: 27448051 DOI: 10.1055/s-0042-110650] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND STUDY AIM The aim of the study was to compare the latest narrow-band imaging (NBI) device with high-definition white light (HDWL) endoscopy for accuracy of real-time optical diagnosis of small colorectal polyps. PATIENTS AND METHODS We conducted a randomized, prospective, multicenter trial at three study sites in Germany. In the NBI arm, endoscopists used NBI for the prediction of polyp pathology on the basis of the NBI International Colorectal Endoscopic classification. In the HDWL arm, NBI was not used for optical classification of polyp histology. The primary outcome was accuracy of optical diagnoses (neoplastic vs. non-neoplastic) in small polyps measuring < 10 mm. Secondary end points included sensitivity and negative predictive value (NPV). RESULTS A total of 380 patients were randomized 1:1 to either the NBI or HDWL arm. A total of 421 polyps measuring < 10 mm were detected (55.8 % neoplastic, 44.2 % non-neoplastic). Accuracy, sensitivity, and NPV were 73.7 %, 82.4 %, and 75.5 %, respectively, in the NBI arm and 79.2 %, 79.8 %, and 73.4 %, respectively, in the HDWL arm (P = 0.225, P = 0.667, P = 0.765). More polyps were assessed with high confidence in the HDWL arm (82.6 %) than in the NBI arm (73.7 %; P = 0.038). The NPV of the prediction of neoplastic histology in diminutive polyps (≤ 5 mm) rated with high confidence was 90.3 % in the NBI arm. We detected significant differences between the participating study sites in the performance data of predictions. CONCLUSION The levels of accuracy for real-time prediction of polyp histology (< 10 mm) did not differ between NBI and HDWL for optical diagnosis. Variation in the performance of optical diagnosis was apparent between study centers. TRIAL REGISTRATION ClinicalTrials.gov (NCT02009774).
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Affiliation(s)
- Peter Klare
- II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Bernhard Haller
- Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Sandra Wormbt
- II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Ellen Nötzel
- Innere Medizin I, Sana Klinikum Lichtenberg, Berlin, Germany
| | - Dirk Hartmann
- Innere Medizin I, Sana Klinikum Lichtenberg, Berlin, Germany
| | - Jörg Albert
- Medizinische Klinik 1, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Johannes Hausmann
- Medizinische Klinik 1, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Henrik Einwächter
- II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Andreas Weber
- II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Mohamed Abdelhafez
- II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Roland M Schmid
- II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Stefan von Delius
- II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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