Single-operator cholangioscopy is useful for visual assessment of bile duct pathology

TY - JOUR

T1 - Single-operator cholangioscopy is useful for visual assessment of bile duct pathology

AU - Mellemgaard, Finnur

AU - Strandby, Rune B

AU - Blockmann, Julie

AU - Kofoed, Steen C

AU - Svendsen, Lars B

AU - Achiam, Michael P

N1 - Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

PY - 2018/8

Y1 - 2018/8

N2 - INTRODUCTION: Single-operator cholangioscopy (SOC) is increasingly used for evaluation of the biliary tree following endoscopic retrograde cholangiopancreaticography (ERCP). This study aimed to determine the visual and histological success rates of SOC at a single Danish tertiary referral centre.METHODS: All patients undergoing SOC between 2008 and 2015 were retrospectively included from a prospectively maintained database. Patient characteristics and proced-ure-related variables were obtained from medical records. A visual and a histological success rate were determined according to predefined criteria.RESULTS: In total, 54 patients underwent SOC, most often due to suspicion of malignancy (n = 53; 98%). In one case, access to the common bile duct failed, and in six cases malignant disease was missed. Thus, the cholangioscopies were successful in 47 of 54 procedures corresponding to a visual success rate of 87%. Nine patients (17%) had a mean of 1.3 ± 1.0 SOC-guided biopsies taken. The extracted tissue was inadequate for histological evaluation in seven of nine cases, corres-pond-ing to a histological success rate of 22% (two out of nine tissue samples were eligible for histological diagnosis).CONCLUSIONS: Considering the reasonable visual success rate, SOC seems to be a useful extension of ERCP during diagnostic work-up for detection of malignant disease in the biliary tree. However, one biopsy per patient is insufficient for histological verification of common bile duct malignancy.TRIAL REGISTRATION: The Danish Health Authority (3-3013-1299/1) and The Danish Data Protection Agency (RH-2015-229).FUNDING: none.

AB - INTRODUCTION: Single-operator cholangioscopy (SOC) is increasingly used for evaluation of the biliary tree following endoscopic retrograde cholangiopancreaticography (ERCP). This study aimed to determine the visual and histological success rates of SOC at a single Danish tertiary referral centre.METHODS: All patients undergoing SOC between 2008 and 2015 were retrospectively included from a prospectively maintained database. Patient characteristics and proced-ure-related variables were obtained from medical records. A visual and a histological success rate were determined according to predefined criteria.RESULTS: In total, 54 patients underwent SOC, most often due to suspicion of malignancy (n = 53; 98%). In one case, access to the common bile duct failed, and in six cases malignant disease was missed. Thus, the cholangioscopies were successful in 47 of 54 procedures corresponding to a visual success rate of 87%. Nine patients (17%) had a mean of 1.3 ± 1.0 SOC-guided biopsies taken. The extracted tissue was inadequate for histological evaluation in seven of nine cases, corres-pond-ing to a histological success rate of 22% (two out of nine tissue samples were eligible for histological diagnosis).CONCLUSIONS: Considering the reasonable visual success rate, SOC seems to be a useful extension of ERCP during diagnostic work-up for detection of malignant disease in the biliary tree. However, one biopsy per patient is insufficient for histological verification of common bile duct malignancy.TRIAL REGISTRATION: The Danish Health Authority (3-3013-1299/1) and The Danish Data Protection Agency (RH-2015-229).FUNDING: none.

KW - Aged

KW - Bile Ducts/pathology

KW - Biliary Tract Diseases/diagnostic imaging

KW - Biopsy

KW - Cholangiopancreatography, Endoscopic Retrograde

KW - Denmark

KW - Endoscopy, Digestive System/methods

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Retrospective Studies

KW - Tertiary Care Centers

M3 - Journal article

C2 - 30059003

SN - 1603-9629

VL - 65

JO - Danish Medical Journal

JF - Danish Medical Journal

IS - 8

M1 - A5496

ER -