Su1146 Comparative Analysis Between Early and Delayed Laparoscopic Cholecystectomy After Percutaneous Transhepatic Gallbladder Drainage

Abstract

G A A b st ra ct s evidence-based consensus statements for the diagnosis of biliary strictures. Methods: Initial statements on the use of CLE for the characterization of indeterminate biliary strictures were developed by a single CLE expert based on the available clinical evidence. Those preliminary statements were edited and submitted by an external group of 16 GI physicians using a modified Delphi approach. After two rounds of votes based on relevant data, quality of the evidence and strength of recommendation, statements were validated if the threshold of agreement was higher than 75%. Results: Out of 9 proposed statements, 7 were validated and 3 rejected.CLE can be used to evaluate biliary strictures, and the probe can be delivered via a catheter or a cholangioscope. CLE is more accurate than ERCP with brush cytology and/or forceps biopsy in determining malignant or benign strictures, using established criteria. The accuracy of CLE in indeterminate biliary strictures may be decreased by prior presence of plastic stent. The Negative Predictive Value (NPV) of CLE is very high. The use of CLE can assist clinical decision-making such as excluding malignancy. CLE should be cited as a valuable tool for an increased diagnostic yield in official guidelines. The «black bands» that can be seen in pCLE images have been shown to be collagen fibrils that predictably increase in pathologic tissue. Conclusion: According to the panel of 16 physicians, given its very high accuracy, Confocal Laser Endomicroscopy has the potential to improve the current diagnostic algorithm of biliary strictures. At centers where expertise is available, Confocal Laser Endomicroscopy used during ERCP in the evaluation of biliary strictures should be considered as a standard practice complementary to conventional tissue sampling.