Endoscopy 2020; 52(S 01): S32
DOI: 10.1055/s-0040-1704100
ESGE Days 2020 oral presentations
Saturday, April 25, 2020 08:30 – 10:30 Cholangioscopy: Current status Liffey Hall 2
© Georg Thieme Verlag KG Stuttgart · New York

DIGITAL-SINGLE-OPERATOR PERORAL CHOLANGIOSCOPY GUIDED BIOPSY VS. ERCP GUIDED BRUSHING FOR INDETERMINATE BILIARY STRICTURES - A PROSPECTIVE, RANDOMIZED MULTICENTER TRIAL

C Gerges
1   EVK Duesseldorf, Innere Medizin, Duesseldorf, Germany
,
T Beyna
1   EVK Duesseldorf, Innere Medizin, Duesseldorf, Germany
,
RSY Tang
2   Prince of Wales Hospital, Institute of Digestive Disease, Hong Kong, China
,
F Bahin
1   EVK Duesseldorf, Innere Medizin, Duesseldorf, Germany
,
JYW Lau
3   Prince of Wales Hospital, Department of Surgery, Hong Kong, China
,
E van Geenen
4   Radboud University Nijmegen Medical Centre, Radboud University of Nijmegen, Gastroenterology, Nijmegen, Netherlands
,
T Dertmann
1   EVK Duesseldorf, Innere Medizin, Duesseldorf, Germany
,
H Neuhaus
1   EVK Duesseldorf, Innere Medizin, Duesseldorf, Germany
,
N Reddy
5   Asian Institute of Gastroenterology, Gastroenterology, Hyderabad, India
,
M Ramchandani
5   Asian Institute of Gastroenterology, Gastroenterology, Hyderabad, India
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims Accurate diagnosis of indeterminate biliary strictures is challenging but important for patient prognostication and further management. Biopsy under direct cholangioscopic vision might be superior to standard endoscopic retrograde cholangiopancreatography (ERCP) techniques such as brushing or biopsy. Our aim was to investigate whether digital single operator cholangioscopy (DSOC) compared to standard ERCP work-up improves the diagnostic yield in patients with indeterminate biliary strictures.

Methods Patients with an indeterminate biliary stricture on the basis of MRCP were randomized to standard ERCP visualization with tissue brushing (Control Arm, CA) or DSOC visualization and DSOC guided biopsy (Study Arm, SA). This was a prospective international multicenter trial with a procedure blinded pathologist.

Results First sample sensitivity of DSOC guided biopsies was significantly higher than ERCP guided brushing (SA 68.2% vs CA 21.4%, P< 0.01). The sensitivity of visualization (SA 95.5% vs. CA 66.7%; P=0.02) and overall accuracy (SA 87.1% vs. CA 65.5%, P=0.05) were significantly higher in the SA compared to the CA while specificity, positive predictive value, and negative predictive value showed no significant difference. Adverse events were equally low in both arms.

Conclusions DSOC guided biopsies were shown to be safe and effective with a higher sensitivity compared to standard ERCP techniques in the visual and histopathological diagnosis of indeterminate biliary strictures.