Using single-operator cholangioscopy for endoscopic evaluation of indeterminate biliary strictures: results from a...

Area of Science:

• Gastroenterology
• Endoscopy
• Hepatobiliary Medicine

Background:

• Indeterminate biliary strictures present diagnostic challenges.
• Peroral cholangioscopy (POCS) aims for diagnosis via visualization and targeted biopsies.
• Evaluating POCS performance in a real-world setting is crucial.

Purpose of the Study:

• To assess the diagnostic performance and safety of POCS for indeterminate biliary strictures.
• To determine the effectiveness of POCS in guiding patient management.
• To evaluate the accuracy of both visual impression and histological sampling from POCS.

Main Methods:

• Prospective, multinational registry of patients with indeterminate biliary strictures across 20 centers.
• Primary endpoints included lesion visualization, histological sampling success, and diagnostic accuracy for malignancy.
• Patients were followed for 6 months post-POCS or until a definitive diagnosis.

Main Results:

• POCS successfully visualized strictures in 98.6% of cases.
• Adequate biopsies were obtained in 92.9% of intended cases.
• Visual impression accuracy was 77.2%, while POCS-guided histology achieved 86.5% accuracy for malignancy.

Conclusions:

• POCS is an effective and safe endoscopic procedure for indeterminate biliary strictures.
• The technique significantly aids in clarifying the cause of biliary strictures and guiding management.
• Real-world data supports POCS as a valuable diagnostic intervention.