Diagnostic accuracy and therapeutic efficacy of digital single-operator cholangioscopy for biliary lesions and stenosis

Introduction:

Digital single-operator cholangioscopy (dSOC) has revolutionized bile duct visualization during endoscopic retrograde cholangiography (ERC). Interventions like electrohydraulic or laser lithotripsy, inspection of suspicious areas and taking targeted biopsies have become possible quick and easy. One main indication for dSOC remains the evaluation of indeterminate biliary strictures.

Patients and Methods:

In this study 180 dSOCs performed 2016 till 2017 in a high volume tertiary center have been retrospectively analyzed to evaluate sensitivity, specificity as well as positive and negative predictive values for indeterminate strictures and lesions. Furthermore technical success and complications were analyzed.

Results:

In 92 – 97% the region of interest was reached and visualized and in 83 – 100% successful biopsies were taken in the biliary tract in this study. Only the distal bile duct was less successful with only 84% and 62%, respectively. The procedure was safe with cholangitis as main complication. Regarding the diagnostic accuracy of dSOC of indeterminate biliary lesions and strictures we found a sensitivity of 0.87 and specificity of 0.88. The investigators assessment directly after dSOC had a positive predictive value of 0.63 and a very high negative predictive value of 0.97.

Conclusions:

Our study demonstrates that dSOC has a very high diagnostic efficacy as well as a favorable safety profile. Therefore, it should be discussed as standard of care in addition to ERC for indeterminate biliary lesions.