Direct peroral cholangioscopy for diagnosis of bile duct lesions using an I-SCAN ultraslim endoscope: a pilot study

Abstract

Background and study aims I-SCAN is a computed virtual chromoendoscopy (CVC) system designed to enhance surface and vascular patterns. In this study, we evaluated the usefulness of direct peroral cholangioscopy (POC) using I-SCAN compared with a conventional white-light image (WLI) to diagnose bile duct lesions.

Patients and methods Patients with mucosal lesions in the bile duct detected during direct POC were enrolled prospectively. The quality of endoscopic visualization and the visual diagnosis were assessed using I-SCAN and WLI modes, respectively, during direct POC.

Results A total of 20 patients (9 malignant and 11 benign lesions) underwent I-SCAN to evaluate lesions in the bile duct using direct POC. The quality of endoscopic visualization using direct POC with I-SCAN was significantly higher than that of WLI for surface structure (P = 0.04), surface microvascular architecture (P = 0.01), and margins (P = 0.02). Overall diagnostic accuracy of the visual diagnosis was not different between I-SCAN and WLI (90.0 % vs. 75.0 %; P = 0.20).

Conclusion Direct POC using CVC by I-SCAN seems to be helpful for evaluating mucosal lesions of the bile duct, without the interference from bile.

Clinical trial registration: UMIN000021009

• References

• 1 Moon JH, Terheggen G, Choi HJ. et al. Peroral cholangioscopy: diagnostic and therapeutic applications. Gastroenterology 2013; 144: 276-282
• 2 Itoi T, Sofuni A, Itokawa F. et al. Peroral cholangioscopic diagnosis of biliary-tract diseases by using narrow-band imaging (with videos). Gastrointest Endosc 2007; 66: 730-736
• 3 Osanai M, Itoi T, Igarashi Y. et al. Peroral video cholangioscopy to evaluate indeterminate bile duct lesions and preoperative mucosal cancerous extension: a prospective multicenter study. Endoscopy 2013; 45: 635-642
• 4 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
• 5 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
• 6 Seo DW, Lee SK, Yoo KS. et al. Cholangioscopic findings in bile duct tumors. Gastrointest Endosc 2000; 52: 630-634
• 7 Fukuda Y, Tsuyuguchi T, Sakai Y. et al. Diagnostic utility of peroral cholangioscopy for various bile-duct lesions. Gastrointest Endosc 2005; 62: 374-382
• 8 Kawakami H, Kuwatani M, Etoh K. et al. Endoscopic retrograde cholangiography versus peroral cholangioscopy to evaluate intraepithelial tumor spread in biliary cancer. Endoscopy 2009; 41: 959-964
• 9 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
• 10 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
• 11 ASGE Technology Committee, Manfredi MA, Abu Dayyeh BK et al. Electronic chromoendoscopy. Gastrointest Endosc 2015; 81: 249-261
• 12 Hoffman A, Basting N, Goetz M. et al. High-definition endoscopy with i-Scan and Lugol’s solution for more precise detection of mucosal breaks in patients with reflux symptoms. Endoscopy 2009; 41: 107-112
• 13 Hoffman A, Kagel C, Goetz M. et al. Recognition and characterization of small colonic neoplasia with high-definition colonoscopy using i-Scan is as precise as chromoendoscopy. Dig Liver Dis 2010; 42: 45-50
• 14 Lee CK, Lee SH, Hwangbo Y. Narrow-band imaging versus I-Scan for the real-time histological prediction of diminutive colonic polyps: a prospective comparative study by using the simple unified endoscopic classification. Gastrointest Endosc 2011; 74: 603-609
• 15 Hoffman A, Korczynski O, Tresch A. et al. Acetic acid compared with i-scan imaging for detecting Barrett’s esophagus: a randomized, comparative trial. Gastrointest Endosc 2014; 79: 46-54