Per-oral cholangioscopy in patients with primary sclerosing cholangitis: a 12-month follow-up study

Rachid Mohamed; Sooraj Tejaswi; Lars Aabakken; Cyriel Y Ponsioen; Christopher L Bowlus; Douglas G Adler; Nauzer Forbes; Vemund Paulsen; Rogier P. Voermans; Shiro Urayama; Joyce Peetermans; Matthew J Rousseau; Bertus Eksteen

doi:10.1055/a-2236-7557

Endoscopy International Open, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(02): E237-E244
DOI: 10.1055/a-2236-7557

Original article

Per-oral cholangioscopy in patients with primary sclerosing cholangitis: a 12-month follow-up study

Rachid Mohamed

¹Gastroenterology and Hepatology, University of Calgary, Calgary, Canada (Ringgold ID: RIN103136)

,

Sooraj Tejaswi

²Division of Gastroenterology & Hepatology, University of California Davis School of Medicine, Sacramento, United States (Ringgold ID: RIN12218)

,

Lars Aabakken

³Dept of Transplantation Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway (Ringgold ID: RIN6305)

,

Cyriel Y Ponsioen

⁴Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, Netherlands (Ringgold ID: RIN522567)

,

Christopher L Bowlus

²Division of Gastroenterology & Hepatology, University of California Davis School of Medicine, Sacramento, United States (Ringgold ID: RIN12218)

,

Douglas G Adler

⁵Center for Advanced Therapeutic Endoscopy, Adventist Porter Hospital, Denver,

,

Nauzer Forbes

⁶Gastroenterology and Hepatology, University of Calgary, Calgary, Canada (Ringgold ID: RIN70401)

,

Vemund Paulsen

³Dept of Transplantation Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway (Ringgold ID: RIN6305)

,

Rogier P. Voermans

⁴Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, Netherlands (Ringgold ID: RIN522567)

,

Shiro Urayama

²Division of Gastroenterology & Hepatology, University of California Davis School of Medicine, Sacramento, United States (Ringgold ID: RIN12218)

,

Joyce Peetermans

⁷Clinical Endoscopy, Boston Scientific Corporation, Marlborough, United States

,

Matthew J Rousseau

⁷Clinical Endoscopy, Boston Scientific Corporation, Marlborough, United States

,

Bertus Eksteen

⁸Gastroenterology, Aspen Woods Clinic, Calgary, Canada

› Institutsangaben

Abstract

Background and study aims Patients with primary sclerosing cholangitis (PSC) have a 9% to 20% lifetime incidence of cholangiocarcinoma (CCA). Per-oral cholangioscopy (POCS) added to endoscopic retrograde cholangiography (ERC) could potentially improve detection of CCA occurrence. We prospectively assessed POCS identification of 12-month CCA incidence in PSC patients undergoing ERC.

Patients and methods Consecutive patients with PSC, an indication for ERC, and no prior liver transplantation were enrolled. During the index procedure, POCS preceded planned therapeutic maneuvers. The primary endpoint was ability for POCS visualization with POCS-guided biopsy to identify CCA during 12-month follow-up. Secondary endpoints included ability of ERC/cytology to identify CCA, repeat ERC, liver transplantation, and serious adverse events (SAEs).

Results Of 42 patients enrolled, 36 with successful cholangioscope advancement were analyzed. Patients had a mean age 43.5±15.6 years and 61% were male. Three patients diagnosed with CCA had POCS visualization impressions of benign/suspicious/suspicious, and respective POCS-guided biopsy findings of suspicious/positive/suspicious for malignancy at the index procedure. The three CCA cases had ERC visualization impressions of benign/benign/suspicious, and respective cytology findings of atypical/atypical/suspicious for malignancy. No additional patients were diagnosed with CCA during median 11.5-month follow-up. Twenty-three repeat ERCs (5 including POCS) were performed in 14 patients. Five patients had liver transplantation, one after CCA diagnosis and four after benign cytology at the index procedure. Three patients (7.1%) had post-ERC pancreatitis. No SAEs were POCS-related.

Conclusions In PSC patients, POCS visualization/biopsy and ERC/cytology each identified three cases of CCA. Some patients had a repeat procedure and none experienced POCS-related SAEs.

Keywords

Cholangioscopy - Pancreatobiliary (ERCP/PTCD) - Diagnostic ERC - Endoscopy Upper GI Tract - Malignant strictures

Volltext

Referenzen

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