Comparison of disposable digital single-operator cholangioscopy versus direct peroral cholangioscopy for the diagnosis of intraductal superficial lesions of the bile duct

Abstract

Background Disposable digital single-operator cholangioscopy (D-SOC) and direct peroral cholangioscopy (D-POC) using an ultraslim endoscope are established POC modalities for the diagnosis and treatment of various biliary diseases. We compared the usefulness of D-SOC and D-POC for the diagnosis of intraductal superficial lesions of the bile duct (ISL-Bs).

Methods 38 consecutive patients with suspected biliary diseases who underwent both D-SOC and D-POC were enrolled. The primary outcome was ISL-B detection rate, and the secondary outcomes were technical success of POC and POC-guided forceps biopsy sampling (POC-FB), procedure time, visualization quality, and tissue adequacy.

Results D-SOC had a higher technical success rate than D-POC but the difference was not statistically significant (100% vs. 92.1%, P = 0.25). D-POC had a marginally higher ISL-B detection rate (34.2% vs. 28.9%, P = 0.68) and significantly higher visualization quality (P = 0.03). The mean (SD) procedure time was significantly shorter with D-SOC (11.00 [1.33] vs. 19.03 [2.95] minutes, P<0.001). The technical success rate of POC-FB and tissue adequacy did not differ between the two techniques (D-SOC vs. D-POC: 81.8% vs. 84.6%, P = 0.69 and 77.8% vs. 90.9%, P = 0.57, respectively).

Conclusions Both POC systems were safe and useful for the detection, characterization, and diagnosis of minute ISL-Bs. While D-SOC displayed a shorter procedure time and a tendency for higher technical success rate, D-POC provided superior visualization quality, allowing detailed observation of the surface structure and microvascular patterns.

• References

• 1 Mounzer R, Austin GL, Wani S. et al. Per-oral video cholangiopancreatoscopy with narrow-band imaging for the evaluation of indeterminate pancreaticobiliary disease. Gastrointest Endosc 2017; 85: 509-517
• 2 Tringali A, Lemmers A, Meves V. et al. Intraductal biliopancreatic imaging: European Society of Gastrointestinal Endoscopy (ESGE) technology review. Endoscopy 2015; 47: 739-753
• 3 Shin IS, Moon JH, Lee YN. et al. Use of peroral cholangioscopy to screen for neoplastic bile duct lesions in patients with bile duct stones (with videos). Gastrointest Endosc 2021; 94: 776-785
• 4 Chen YK, Parsi MA, Binmoeller KF. et al. Single-operator cholangioscopy in patients requiring evaluation of bile duct disease or therapy of biliary stones (with videos). Gastrointest Endosc 2011; 74: 805-814
• 5 Draganov PV, Chauhan S, Wagh MS. et al. Diagnostic accuracy of conventional and cholangioscopy-guided sampling of indeterminate biliary lesions at the time of ERCP: a prospective, long-term follow-up study. Gastrointest Endosc 2012; 75: 347-353
• 6 Ogura T, Imanishi M, Kurisu Y. et al. Prospective evaluation of digital single-operator cholangioscope for diagnostic and therapeutic procedures (with videos). Dig Endosc 2017; 29: 782-789
• 7 Moon JH, Terheggen G, Choi HJ. et al. Peroral cholangioscopy: diagnostic and therapeutic applications. Gastroenterology 2013; 144: 276-282
• 8 Parsi MA, Jang S, Sanaka M. et al. Diagnostic and therapeutic cholangiopancreatoscopy: performance of a new digital cholangioscope. Gastrointest Endosc 2014; 79: 936-942
• 9 Parsi MA, Stevens T, Bhatt A. et al. Digital, catheter-based single-operator cholangiopancreatoscopes: can pancreatoscopy and cholangioscopy become routine procedures?. Gastroenterology 2015; 149: 1689-1690
• 10 Lee YN, Moon JH, Choi HJ. et al. Direct peroral cholangioscopy for diagnosis of bile duct lesions using an I-SCAN ultraslim endoscope: a pilot study. Endoscopy 2017; 49: 675-681
• 11 Lee YN, Moon JH, Choi HJ. et al. A newly modified access balloon catheter for direct peroral cholangioscopy by using an ultraslim upper endoscope (with videos). Gastrointest Endosc 2016; 83: 240-247
• 12 Nakayoshi T, Tajiri H, Matsuda K. et al. Magnifying endoscopy combined with narrow band imaging system for early gastric cancer: correlation of vascular pattern with histopathology (including video). Endoscopy 2004; 36: 1080-1084
• 13 Choi HJ, Moon JH, Lee YN. Advanced imaging technology in biliary tract diseases: narrow-band imaging of the bile duct. Clin Endosc 2015; 48: 498-502
• 14 Shin IS, Moon JH, Lee YN. et al. Detection and endoscopic classification of intraductal neoplasms of the bile duct by peroral cholangioscopy with narrow-band imaging (with videos). Gastrointest Endosc 2023; 97: 898-910
• 15 Lee YN, Moon JH, Lee TH. Prospective randomized trial of a new multibending versus conventional ultra-slim endoscope for peroral cholangioscopy without device or endoscope assistance (with video). Gastrointest Endosc 2020; 91: 92-101
• 16 Lee TH, Moon JH, Lee YN. et al. A preliminary study on the efficacy of single-operator cholangioscopy with a new basket for residual stone retrieval after mechanical lithotripsy. Dig Dis Sci 2022; 67: 2571-2576
• 17 Choi HJ, Moon JH, Ko BM. et al. Overtube-balloon-assisted direct peroral cholangioscopy by using an ultra-slim upper endoscope (with videos). Gastrointest Endosc 2009; 69: 935-940
• 18 Moon JH, Ko BM, Choi HJ. et al. Intraductal balloon-guided direct peroral cholangioscopy with an ultraslim upper endoscope (with videos). Gastrointest Endosc 2009; 70: 297-302
• 19 Lee YN, Moon JH, Lee TH. et al. Efficacy and safety of direct peroral cholangioscopy using a new multibending ultra-slim endoscope for the management of biliary diseases. J Hepatobiliary Pancreat Sci 2022; 29: 1292-1299
• 20 Sethi A, Chen YK, Austin GL. et al. ERCP with cholangiopancreatoscopy may be associated with higher rates of complications than ERCP alone: a single-center experience. Gastrointest Endosc 2011; 73: 251-256
• 21 Shin IS, Moon JH, Lee YN. et al. Efficacy of narrow-band imaging during peroral cholangioscopy for predicting malignancy of indeterminate biliary strictures (with videos). Gastrointest Endosc 2022; 96: 512-521
• 22 Kim HK, Moon JH, Choi HJ. et al. Early bile duct cancer detected by direct peroral cholangioscopy with narrow-band imaging after bile duct stone removal. Gut Liver 2011; 5: 377-379
• 23 Navaneethan U, Hasan MK, Lourdusamy V. et al. Single-operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate biliary strictures: a systematic review. Gastrointest Endosc 2015; 82: 608-614
• 24 Lee WM, Moon JH, Lee YN. et al. Utility of direct peroral cholangioscopy using a multibending ultraslim endoscope for difficult common bile duct stones. Gut Liver 2022; 16: 599-605
• 25 Lee WM, Moon JH, Lee YN. et al. Usefulness of direct peroral cholangioscopy using a multibending ultraslim endoscope for the management of intrahepatic bile duct lesions (with videos). Gut Liver 2024; 18: 358-364
• 26 Itoi T, Sofuni A, Itokawa F. et al. Evaluation of peroral videocholangioscopy using narrow-band imaging for diagnosis of intraductal papillary neoplasm of the bile duct. Dig Endosc 2009; 21: S103-107
• 27 Moon JH, Ko BM, Choi HJ. et al. Direct peroral cholangioscopy using an ultra-slim upper endoscope for the treatment of retained bile duct stones. Am J Gastroenterol 2009; 104: 2729-2733
• 28 Brewer Gutierrez OI, Bekkali NLH, Raijman I. et al. Efficacy and safety of digital single-operator cholangioscopy for difficult biliary stones. Clin Gastroenterol Hepatol 2018; 16: 918-926