The role and utility of cholangioscopy for diagnosing indeterminate biliary strictures

Abstract

Biliary strictures are considered indeterminate when evaluation with imaging and standard tissue sampling during endoscopic retrograde cholangiopancreatography (ERCP) are non-diagnostic. Standard tissue sampling techniques include cytologic brushings, with or without fluorescence in situ hybridization (FISH), and endoscopic intraductal biopsies. These strictures are often clinically suspicious for malignancy. The management of these patients can vary substantially and relies on an accurate diagnosis of the lesion. Unfortunately, despite numerous modalities, the sensitivity of existing tissue sampling techniques remains low and can lead to delays in diagnosis and the need for additional procedures. Cholangioscopy has emerged as a means to visually inspect and obtain image-guided biopsies of the lesion in question, with improved sensitivity as well as a high specificity and accuracy for diagnosing the etiology of indeterminate biliary strictures. The types of cholangioscopy systems and a summary of the pertinent literature are discussed in this review.

Cholangioscopic classification of post‐living donor liver transplantation biliary strictures can predict their natural history and response to therapy

“…One, 14 and eight patients belonged to Child-Turcotte-Pugh (CTP) Class A, B and C respectively (excluding the patient who was transplanted for ALF). Median Model for End-Stage Liver Disease (MELD) score was 15 (13)(14)(15)(16)(17)(18)(19)(20). ABOincompatible transplant was performed in 1 (4.1%) patient, while hepatocellular carcinoma (HCC) was present in 4 (16.6%) patients.…”

“…Cholangioscopy [16][17][18] is an interesting, however, underutilized adjunct in the endoscopist's armamentarium which can increase the technical success of the procedure. Most of the experience pertaining to cholangioscopy till now has been limited to indeterminate 19 biliary strictures. Therefore, we undertook this study to examine the morphology of post-LDLT anastomotic biliary strictures using cholangioscopy and assess the impact of stricture morphology on the prognosis.…”

Endoscopic Management of Difficult Biliary Stones: An Evergreen Issue

“…Apparently, the D-SOC system improves the diagnostic yield during ERCP for pancreaticobiliary diseases and it also diminishes the procedure time, resulting in minimum radiation exposure, compared to fiber scopes SOC [53] (Figure 4). Direct peroral cholangioscopy (DPOC) is a technological advancement that has also been introduced to the market with a larger working channel and electronic chromoendoscopy capabilities [54]. However, DPOC appears more challenging since there is a risk of gastric looping, while cases of air embolization have also been reported.…”