Aims:
Single-operator cholangioscopy (SOC) has been a major advance in indeterminate biliary
stricture (IDBS) diagnosis because it has made direct visualization and optically
guided biopsy of these lesions. However, SOC-guided biopsies have shown limited sensitivity.
In order to overcome this limitation, identifying the cholangioscopic features that
most strongly suggest malignancy is an interesting way to improve SOC diagnostic capabilities;
however, no systematic analysis of SOC findings has been conducted to date.
The aim of our study is to establish endoscopic criteria allowing to distinguish between
benign and malignant lesions.
Methods:
4 referral centers included 98 Spyglass DS cholangioscopy recordings performed for
indeterminate biliary strictures (IDBS) whose final diagnosis was known by histology
or follow-up for more than 1 year. 7 experts in cholangioscopy participated in the
development of a consensual reading grouping 20 semiological criteria. The videos
were analyzed individually by each expert after randomization according to the reading
grid. A hypothesis diagnosis was issued for each examination. After a statistic analysis
a second meeting with the same methodology were held for criteria validation.
Results:
98 IDBS videos from 95 patients of mean age 66 years (13 – 89) were analyzed; there
were 38 benign and 60 malignant strictures. The Sensitivity ranged from 68% to 81%
and specificity from 55 to 71%. The univariate and multivariate analysis identified
4 significant criteria. One for benign lesions: the presence of endobiliary material
odds ratio (OR)= 0.649; 95% confidence interval (CI), 0.427 – 0.988. Three for malignant
lesions: villous pattern OR = 1.477; 95% CI, 0.98 – 2.21; irregular vessels OR = 2.042;
95% CI, 1.35 – 3.08; redish aspect OR = 1.67; 95% CI,1.09 – 2.53.
Conclusions:
Simple criteria's could assist malignancy diagnosis and enhance The performance of
cholangioscopic visual diagnosis of IDBS.
