Digital single-operator cholangioscopy characterizes distinct phenotypes of primary sclerosing cholangitis

Introduction: Primary sclerosing cholangitis (PSC) carries a high risk for cholangiocarcinoma (CCA) development. Digital single-operator cholangioscopy (dSOC) is commonly recommended for evaluating indeterminate biliary strictures and suspected biliary malignancy. However, in the context of PSC, clinical guideline recommendations for the use of dSOC vary across countries and are based on limited scientific evidence.

Methods: This retrospective, single-center study aimed to characterize the cholangioscopic features of patients with PSC. dSOC findings and reports were evaluated based on visual assessment, categorizing the cholangioscopic appearance into a fibrotic-predominant, an inflammatory-predominant, or suspicious for malignancy phenotype.

Results: In a cohort of 77 PSC patients, 44 individuals (mean age 45 years [range 20–67]; 15 female, 29 male) underwent dSOC between 2014 and 2022, with a total of 132 dSOC procedures being analyzed. Six patients in the cohort were newly diagnosed with CCA. In 54 cases (40.9%), a fibrotic-predominant phenotype was identified, while 62 cases (47%) exhibited an inflammatory-predominant phenotype. Sixteen cases (12.1%) were suspicious for malignancy, with 14 of these showing a predominance of inflammatory features (10.2%). CCA diagnoses were predominantly confirmed in patients with the inflammatory-predominant phenotype (82.4%).

Conclusion: We characterize distinct cholangioscopic phenotypes in primary sclerosing cholangitis. The findings suggest that cholangiocarcinoma in PSC is associated with a predominantly inflammatory cholangioscopic phenotype, indicating the need for early implementation of cholangioscopy in the diagnostic evaluation of PSC to identify patients at higher risk for developing CCA.

Publication History

Article published online:
20 January 2025