Introduction The precise assessment of a biliary stricture can be challenging. Multi-modal imaging with CT/MR and EUS can generally determine the nature of a biliary stricture and EUS in particular, can offer histological diagnosis. However, ERCP is often necessary for diagnostic evaluation and management of biliary strictures and biliary cytology performed at ERCP has a diagnostic yield of only 10–40%. Assessment of focal intrahepatic strictures can thus, be even more difficult. Cholangioscopy offers the advantage of tissue sampling under direct vision, thereby enhancing diagnostic precision. The aim of the study was to review our experience of cholangioscopy in the assessment of biliary strictures.
Methods A review of a prospectively maintained database of all procedures involving per oral single operator cholangioscopy at our institution (June 2008–2011), was performed. “Indeterminate” strictures were defined as biliary strictures referred for diagnostic evaluation with previous negative cytology. Other biliary strictures were referred for evaluation after negative EUS-FNA, or directly based on radiological abnormalities. Follow-up data were acquired through case note review and phone calls to referring hospitals. Summary statistics were applied.
Results 72 patients underwent cholangioscopy for “indeterminate strictures” during the study period (42 males, mean age 64 years (SD 11)). These patients had a total of 228 investigations performed as part of their evaluation (mean 3 investigations/person). 39 (54%) had a previous ERCP (range 1–6 procedures per person). At cholangioscopy, adequate mucosal visualisation was achieved in 64 (89%) and direct biopsy sampling was carried out in 36 (50%) patients. 35 patients needed prior sphincterotomy. Tissue diagnosis was achieved in 54 (75%) patients (15 cholangiocarcinoma, 5 PSC-related strictures, 12 ischaemic/inflammatory, 1 biliary leiomyoma and 21 normal tissue). 6 (10%) had complications related to the procedure (5 cholangitis, 1 post-sphincterotomy bleed). On follow-up (mean 10 months (range 2–24 months), four patients underwent surgery (2 cholangiocarcinoma, 2 ischaemic/inflammatory strictures), 13 had endoscopic palliation for cholangiocarcinoma, of which seven died (mean 9 months).
Conclusion Cholangioscopy is valuable tool in the diagnostic evaluation of biliary strictures.
Competing interests None declared.
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