Endoscopy 2020; 52(S 01): S160-S161
DOI: 10.1055/s-0040-1704495
ESGE Days 2020 ePoster Podium presentations
Friday, April 24, 2020 09:30 – 10:00 Cholangioscopy: Strictures ePoster Podium 2
© Georg Thieme Verlag KG Stuttgart · New York

DIAGNOSIS OF BILIARY STRICTURES USING SPYGLASS DIRECTED BIOPSIES - INTENTION TO TREAT ANALYSIS AT A TERTIARY CARE CENTER

K Soota
1   University of Alabama at Birmingham, Birmingham, U S A
,
MM Abdelfatah
1   University of Alabama at Birmingham, Birmingham, U S A
,
CM Wilcox
1   University of Alabama at Birmingham, Birmingham, U S A
,
KRKK Baig
1   University of Alabama at Birmingham, Birmingham, U S A
,
S Peter
1   University of Alabama at Birmingham, Birmingham, U S A
,
A Ahmed
1   University of Alabama at Birmingham, Birmingham, U S A
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

Also available at
 

Aims Diagnosis of biliary strictures remains clinically arduous. We evaluated the utility of single-operator cholangioscopy (SOC) SpyGlass with and without cytology versus cold biopsies performed during endoscopic retrograde cholangiopancreatography (ERCP) for biliary strictures.

Methods We conducted a retrospective analysis of all biliary strictures. A total of 42 patients (51% males) are included over a period of 3 years. Follow up was complete in 37 patients. The patients were divided into 4 groups - bile duct biopsies only using the SpyGlass system (n=19), bile duct biopsies using the SpyGlass system with cytology brushings (n=8), bile duct biopsies using cold biopsy forceps alone (n=6) and only cytology brushings (n=4).

Results Biliary stricture was located in the common bile duct in 55% patients and the common hepatic duct in 32% patients. The median length was 14.5±8 mm with mean bilirubin of 10+8 mg/dl. Spyglass was successful in all patients except 1. Twenty-five (68%) patients were found to have malignant and 12 (32%) patients had benign lesions. SpyGlass with cytology accurately detected malignancies in 67% of patients with total diagnostic accuracy for all lesions being 75%. SpyGlass biopsies alone accurately diagnosed 64% malignancies, and 79% all lesions. When both these groups were combined, diagnostic accuracy for malignant lesions was 65% and for all lesions was 78%. Diagnostic accuracy for cold biopsy forceps was 75% for malignant lesions and 83% for all lesions. Cytology accurately diagnosed 50% of malignant lesions and 50% of all lesions. One patient diagnosed initially with benign stricture on SpyGlass was later diagnosed as having malignancy when biopsied again using SpyGlass.

Conclusions Performing SpyGlass biopsies has a high rate of technical success. SpyGlass directed biopsies accurately predict diagnosis in 79% of patients. The addition of cytology does not add incremental yield. Forceps biopsy is not always technically feasible, but when possible offers excellent diagnostic yield.