Endoscopy 2020; 52(02): 107-114
DOI: 10.1055/a-1061-7067
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Limited diagnostic accuracy and clinical impact of single-operator peroral cholangioscopy for indeterminate biliary strictures

Adriaan B. de Vries
1  Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
,
Frans van der Heide
1  Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
,
Rinze W. F. ter Steege
2  Department of Gastroenterology and Hepatology, Martini Ziekenhuis, Groningen, The Netherlands
,
Jan Jacob Koornstra
1  Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
,
Karel T. Buddingh
3  Department of Urology, HagaZiekenhuis, Den Haag, The Netherlands
,
Annette S. H. Gouw
4  Department of Pathology, University Medical Center Groningen, Groningen, The Netherlands
,
Rinse K. Weersma
1  Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
› Author Affiliations
Further Information

Publication History

submitted 10 January 2019

accepted after revision 14 October 2019

Publication Date:
13 December 2019 (online)

Abstract

Background Single-operator peroral cholangioscopy (sPOCS) is considered a valuable diagnostic modality for indeterminate biliary strictures. Nevertheless, studies show large variation in its characteristics and measures of diagnostic accuracy. Our aim was to estimate the diagnostic accuracy of sPOCS visual assessment and targeted biopsies for indeterminate biliary strictures. Additional aims were: estimation of the clinical impact of sPOCS and comparison of diagnostic accuracy with brush cytology.

Methods A retrospective single-center study of adult patients who underwent sPOCS for indeterminate biliary strictures was performed. Diagnostic accuracy was defined as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The clinical impact of sPOCS was assessed by review of medical records, and classified according to its influence on patient management.

Results 80 patients were included, with 40 % having primary sclerosing cholangitis (PSC). Prior ERCP was performed in 88 %, with removal of a biliary stent prior to sPOCS in 55 %. The sensitivity, specificity, PPV, and NPV for sPOCS visual impression and targeted biopsies were 64 %, 62 %, 41 %, and 84 %, and 15 %, 65 %, 75 %, and 69 %, respectively. The clinical impact of sPOCS was limited; outcome changed management in 17 % of patients. Sequential brush cytology sensitivity, specificity, PPV, and NPV were 47 %, 95 %, 80 %, and 83 %.

Conclusions The diagnostic accuracy of sPOCS for indeterminate biliary strictures was found to be inferior to brush cytology, with a low impact on patient management. These findings are obtained from a select patient population with a high prevalence of PSC and plastic stents in situ prior to sPOCS.

Supplementary material