Introduction Single-user peroral cholangioscopy (SOC) has been reported to be useful in the differential diagnosis of indeterminate biliary lesions, but its diagnostic utility in sclerosing cholangitis(SC) has not been evaluated.
Methods Fifty-one consecutive patients with sclerosing cholangitis(47 primary SC; 4 IgG4-related cholangitis), who underwent 54 attempted SOC procedures due to indeterminate biliary strictures, in 4 UK and 1 Swedish tertiary referral centres in 2008–2012, were retrospectively enrolled. Brush cytology or SOC-directed biopsies were obtained as clinically indicated. The operating characteristics of SOC for detecting cancer were calculated using a composite reference standard (incl. surgical confirmation, tissue sampling, follow-up). For each SOC procedure in SC, another one attempted due to an indeterminate biliary stricture in patients without SC in the same centre and calendar year was randomly selected as control.
Results The SpyglassTM cholangioscope could be successfully inserted in the bile duct less frequently in SC compared to controls(83% vs 96%, p = 0.05), but the two groups did not differ in the mucosal visualisation success rate(93% vs 94%). SOC-directed biopsies were more commonly performed in SC vs controls (83% vs 61%, p = 0.02) but the rate of adequate samples did not differ significantly (67% vs 77%, p = 0.2). The sensitivity, specificity and accuracy of SOC with/without tissue sampling for cancer diagnosis were similar in the 2 groups(intention-to-diagnose; table). The SOC diagnosis rate of malignant lesions was also similar in SC vs controls (50% vs 55%, p > 0.05). Adverse events were more common in SC, mainly due to an increased frequency of cholangitis (table). No severe adverse events were observed.
Data are presented as medians (IQR) and percentage as appropriate. The 95% confidence intervals of operating characteristics are reported. *p ≤ 0.05.
Conclusion In experienced hands, SOC is equally accurate in cancer diagnosis in SC and patients with single biliary strictures. SOC may be of particular use in the assessment of SC, in which differentiating benign from malignant strictures remains particularly challenging. However, cholangioscope insertion may be hampered by bile duct narrowing and cholangitis is more common following SOC in SC.
Disclosure of Interest None Declared
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