Endoscopic Diagnosis of Biliary Stricture Combined with Digital Cholangioscope: A Case Series

Seiichiro Fukuhara,Takanori Kanai,Shintaro Kawasaki,Minoru Kitago,Eisuke Iwasaki,Yujiro Machida,Masayasu Horibe,Hiroki Tamagawa,Shutaro Hori,Haruhiko Ogata,Atsuto Kayashima,Yuta Abe

doi:10.3390/healthcare10010012

Abstract

The endoscopic diagnosis of biliary tract lesions is applied as a non-invasive method; however, its diagnostic accuracy is not yet high. Moreover, digital cholangioscopy is used for directly visualizing the inside of the bile duct, resulting in a more precise biopsy. We present the case series of the outcomes of diagnosis using digital cholangioscopy in patients who underwent cholangioscopy for the evaluation of biliary stenosis in our department between January 2014 and March 2021. The controls were those who underwent a biopsy for biliary stenosis with conventional endoscopic retrograde cholangiopancreatography (ERCP). Background data for each case were collected, and the clinical outcomes by biopsy were evaluated, focusing on the accuracy of the diagnosis. Cholangioscopy was performed in 15 cases, while a conventional biopsy by ERCP was performed in 172 cases. Nine of 15 cases (60.0%) were diagnosed with cholangiocarcinoma. The number of specimens obtained through conventional ERCP and cholangioscopy was 2.5 ± 1.3 and 3.3 ± 1.5, respectively (p = 0.043). The diagnostic accuracy of conventional ERCP and cholangioscopy were 65.7% (113 of 172 cases) and 100%, respectively, which was significantly higher in the group with cholangioscopy. Digital cholangioscopy is useful when the diagnosis of the biliary stricture using the conventional ERCP method is difficult.

Highlights

Introduction published maps and institutional affilAdvances in endoscopic technology have improved the diagnostic techniques for biliary tract diseases
The examination for conventional biopsy using endoscopic retrograde cholangiopancreatography (ERCP) was performed in 172 cases, while it was performed in 15 cases with cholangioscopy
Compared with the 172 cases that underwent conventional biopsy using ERCP for the diagnosis of biliary stenosis, this study revealed that the diagnostic accuracy was superior in cases with cholangioscopy

Summary

Introduction

Introduction published maps and institutional affilAdvances in endoscopic technology have improved the diagnostic techniques for biliary tract diseases. The diagnoses of biliary tract diseases rely on cholangiography and fluoroscopic biopsy performed via endoscopic retrograde cholangiopancreatography (ERCP). This method is limited by its low sensitivity. A systematic review on the detection of malignant biliary stricture using ERCP revealed that the pooled sensitivity of brushing cytology and forceps biopsy was 45% and 48.1%, respectively [1]. The combination of these two methods resulted in a sensitivity of only 59.4%.

Methods

Discussion

Conclusion