Is single-operator peroral cholangioscopy a useful tool for the diagnosis of indeterminate biliary lesion? A systematic review and meta-analysis

Abstract

Differentiating between malignant and benign biliary lesions is critical in clinical practice but is difficult. To systematically evaluate the diagnostic performance of single-operator peroral cholangioscopy on indeterminate biliary lesions. A systematic review and meta-analysis. Patients with indeterminate biliary lesions or equivocal ERCP findings. The diagnostic performance of single-operator peroral cholangioscopy onindeterminate biliary lesions. The area under the summary receiver-operating characteristic curve was used as the main indicator for the overall diagnostic performance of single-operator peroral cholangioscopy visualimpression (VI) and SpyBite biopsy (SB). The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were also synthesized. A total of 8 studies met the inclusion criteria, involving 335 patients who had data on VI and 337 who haddata on SB. The area under the curve values on the summary receiver-operating characteristic curve of single-operator peroral cholangioscopy VI and SB were 0.94 (95% confidence interval [CI], 0.92-0.96) and 0.93 (95% CI,0.90-0.95) respectively. The combined sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 90% (95% CI, 73%-97%), 87% (95% CI, 76%-94%), 7.1 (95% CI, 3.8-13.3), 0.12 (95% CI, 0.04-0.33) for VIand 69% (95% CI, 57%-79%), 98% (95% CI, 92%-99%), 30.1 (95% CI, 8.5-106.9), and 0.32 (95% CI, 0.23-0.44) forSB, respectively. Small number of included studies; comparison with ERCP could not be made. Single-operator peroral cholangioscopy is a good tool for differentiating malignant and benignbiliary lesions. VI is useful for detecting malignant lesion, whereas SB is better at confirming a malignant diagnosis, but VI is not perfect in excluding biliary cancer, nor is SB, and their negative results should be interpreted with caution.