Digital single-operator peroral cholangioscopy-guided biopsy sampling versus ERCP-guided brushing for indeterminate biliary strictures: a prospective, randomized, multicenter trial (with video)

Abstract

See CME section; p. 1187.

Efficacy and Safety of Digital Single-Operator Cholangioscopy in the Diagnosis of Indeterminate Biliary Strictures by Targeted Biopsies: A Systematic Review and Meta-Analysis

“…Six studies had data on the number biopsies [11,14,15,[17][18][19], while two studies reported the mean biopsy number to be more than two. In the subgroup analysis, the sensitivity of the group with more than two biopsies [14,18] and less than two biopsies [11,15,18,19] was 0.75 (95% CI: 0.68-0.81) and 0.69 (95% CI: 0.49-0.85), respectively, indicating that sufficient biopsy tissues are necessary for an accurate diagnosis. However, future randomized trials are needed to determine the optimal number of biopsies.…”

Cholangiopancreatoscopy: Expanding the Diagnostic Indications of Endoscopic Retrograde Cholangiopancreatography

“…Mini-forceps biopsy provided significantly better sensitivity (76.5% vs. 5.9%, p<0.0001) and overall accuracy (84.6% vs. 53.8%, p=0.0215) compared with standard cytology brushings. A recent study by Gerges et al [34] randomized patients with an indeterminate biliary stricture on the basis of MRCP to standard ERCP visualization with tissue brushing (control arm) or SOC with SOC-guided biopsy sampling. The study showed that the overall accuracy of SOC-guided biopsy samples was significantly higher than ERCP cytology brushing (87.1% vs. 65.5%, p<0.05), whereas specificity, positive predictive value and negative predictive value showed no significant difference.…”

Percutaneous single-operator video cholangioscopy using a novel short disposable endoscope: first clinical case with treatment of a complex biliary stone and inaccessible papilla after Roux-en-Y reconstructive surgery

“…[1][2][3] Direct cholangioscopy has emerged as a cornerstone in the evaluation of indeterminate biliary strictures and in the treatment approach for complex biliary stones. [4][5][6] Currently, no cholangioscopy system on the market can be used via the enteroscopic approach. Thus, these situations usually require a percutaneous approach with the insertion of an endoscope into the bile duct system.…”

“…Its benefits in the evaluation of indeterminate strictures and intraluminal therapy of difficult-to-treat bile duct and pancreatic stones have been studied in clinical trials. 5,10,11 Case reports have shown that the device can also be used as a tool for percutaneous access, although it was formally built for long access over the accessory channel of a standard duodenoscope. [12][13][14][15] However, the single-operator system offers advantages over reusable endoscopes.…”