Su1582 EFFICACY OF DIGITAL SINGLE-OPERATOR CHOLANGIOSCOPY IN THE VISUAL INTERPRETATION OF BILIARY MALIGNANCIES: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Indeterminate biliary stricture remains a significant diagnostic challenge. Digital single-operator cholangioscopy (D-SOC) incorporates digital imaging enabling higher resolution for better visualization and diagnosis of biliary lesions. We aimed to conduct a systematic review and meta-analysis of available literature in an attempt to determine the efficacy of D-SOC in the visual interpretation of biliary malignancies. Electronic searches were performed using Medline (PubMed), EMBASE, and Cochrane Library. All D-SOC studies that reported the diagnostic performance in the visual interpretation of indeterminate biliary strictures and biliary malignancies were included. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 was used to evaluate the quality of the included studies. All data were extracted and pooled to construct a 2x2 table. The visual interpretation of D-SOC was compared with either a surgical specimen or clinical follow-up in the included patients. Pooled sensitivity, specificity, positive predictive value, negative predictive value, prevalence, positive likelihood ratio (+LR), negative likelihood ratio (-LR), and diagnostic odds ratio (OR) were calculated. The summarized receiver operating characteristic (SROC) curve corresponding with the area under the curve (AUC) was also analyzed. The search yielded 465 citations. Out of these, six studies with a total of 283 patients were finally included in the meta-analysis. The overall pooled sensitivity and specificity of D-SOC in the visual interpretation of biliary malignancies was 94% (95% CI 89%-97%) and 95% (95%CI 90%–98%), respectively (Figure 1). While the +LR, -LR, diagnostic OR, and AUC were 15.20 (95%CI 5.21–44.33), 0.08 (95%CI 0.04–0.14), 308.83 (95%CI 106.46–872.82), and 0.983 respectively (Table 1). The heterogeneity among 6 included studies was moderate for specificity (I2=51) and low for sensitivity (I2=17) and diagnostic OR (I2 = 0). D-SOC has excellent efficacy in the visual interpretation of biliary malignancies, and these findings were consistent in all included studies. Thus, accurate visual interpretation with D-SOC should be routinely employed in the evaluation of indeterminate biliary stricture to identify biliary malignancies.View Large Image Figure ViewerDownload Hi-res image Download (PPT)