A feasibility study of digital single-operator cholangioscopy for diagnostic and therapeutic procedure (with videos)

Imanishi, Miyuki; Ogura, Takeshi; Kurisu, Yoshitaka; Onda, Saori; Takagi, Wataru; Okuda, Atsushi; Miyano, Akira; Amano, Mio; Nishioka, Nobu; Masuda, Daisuke; Higuchi, Kazuhide

doi:10.1097/md.0000000000006619

Cited by 23 publications

(20 citation statements)

References 31 publications

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“…Only a few digital SOC studies reported selective guidewire insertion in a limited number of patients (4-7 patients) with success rates of 57-75%. 7,10 Particularly in patients with complex strictures, the enhanced imaging quality of the digital SOC could help identify the ostium of the stricture and may prevent more invasive procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Our results are consistent with other digital SOC studies that report stone removal rates of 86-100%. 7,9,10 According to a meta-analysis including 244 cholangioscopies in patients with difficult stone disease, the success rate for fibre-optic SOC was 87%. 22 We conclude that compared with fibre-optic SOC, for complex stone disease, the improved digital imaging quality might not improve biliary stone clearance.…”

Section: Discussionmentioning

confidence: 99%

“…1,5 To date, only a few studies have evaluated digital SOCs. [6][7][8][9][10] Among these reports, three small studies examined the diagnostic and therapeutic efficacy of digital SOCs, but no study performed an in-depth investigation of adverse events (AEs) related to the examination. 6,9,10 Therefore, the aim of this study was to evaluate the diagnostic efficacy, the success of therapeutic procedures and especially the safety of digital SOCs.…”

Section: Introductionmentioning

confidence: 99%

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Safety, diagnostic accuracy and therapeutic efficacy of digital single‐operator cholangioscopy

et al. 2018

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Background: Digital single-operator cholangioscopes (digital SOCs), equipped with an improved image quality, have been recently introduced. Objective: The aim of this study is to evaluate the safety and diagnostic and therapeutic efficacy of digital SOCs (Spyglass TM DS). Methods: Sixty-seven digital SOC procedures performed between 2015 and 2017 were retrospectively analyzed. Results: The most frequent indications for examination were indeterminate biliary strictures (61.2%) and biliary stone disease (23.9%). In 25 patients (37.3), visual findings predicted malignancy with a sensitivity of 88.9%, a specificity of 97.6%, a positive predictive value (PPV) of 96.0% and a negative predictive value (NPV) of 92.9%. For histological analysis, forceps biopsies were performed in 29 patients (43.2%). Compared with visual findings, forceps biopsies yield a lower diagnostic efficacy in diagnosing malignancy (sensitivity 62.5%, specificity 90.0%, PPV 90.9%, NPV 60.0%). Therapeutic interventions were performed in 19 patients with a technical success rate of 89.4%. Adverse events were observed in 17 patients (25.4%). Of these, 11 patients (16.4%) suffered from severe adverse events (pancreatitis, cholangitis or major bleeding), which led to a prolonged hospital stay. Conclusion: Digital SOCs have excellent diagnostic and therapeutic efficacies, but are accompanied by high rates of adverse events; therefore, physicians should use digital SOCs in carefully selected cases. KeywordsCholangioscopy, SpyGlass DS, adverse events, digital single-operator cholangioscopy, indeterminate biliary strictures, complex biliary stone disease Received: 25 November 2017; accepted: 12 February 2018 Key summaryEstablished knowledge:. Digital single-operator cholangioscopes (digital SOCs) have been recently introduced. New findings:. Digital SOCs have an excellent diagnostic accuracy for biliary tract diseases and a high efficacy for therapeutic interventions including treatment of complex biliary stone disease and biliary strictures. . Our results suggest a high incidence (16.4%) of severe adverse events associated with the examination, which is why digital SOCs should only be used in carefully selected cases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Safety, diagnostic accuracy and therapeutic efficacy of digital single‐operator cholangioscopy

et al. 2018

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“…However, the low specificity of direct visualization alone implies pathologic analysis for definitive diagnosis [2]. Most studies reported an adequate quality sampling in 82–97% of biopsies obtained by CCS [6, 11, 12, 14] with a diagnostic accuracy, sensitivity, and specificity of 49–93%, 49–82%, and 97–98%, respectively [6, 10-12, 14, 15]. The diagnostic accuracy of biliary malignancy increases to 96% when combining cholangioscopic visualization and biopsy [9, 10, 12, 14].…”

mentioning

confidence: 99%

“…Regarding diagnosis of biliary lesions, brush cytology and standard forceps biopsy obtained by indirect visualization under fluoroscopic guidance of the biliary tract have a limited diagnostic accuracy (39–54%) with low sensitivity (6–51%) and specificity (55%) [2, 5, 6, 10, 11]. Recent systematic reviews and meta-analyses evaluated the diagnostic power of peroral cholangioscopy for malignant biliary stricture based on visual impression and CCS-guided biopsies, with a success rate of 90–100% [10, 12, 13].…”

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confidence: 99%