Diagnostic Peroral Video Cholangioscopy Is an Accurate Diagnostic Tool for Patients With Bile Duct Lesions

BACKGROUND & AIMS We evaluated the diagnostic ability of a newly developed peroral video cholangioscopy (PVCS) in patients with pancreaticobiliary disorders METHODS We retrospectively evaluated data from 144 patients with pancreaticobiliary disorders, collected from 5 tertiary referral centers Endoscopic sphincterotomy (EST) or endoscopic pap diary balloon dilation (EPBD) was performed before PVCS We performed 2 types of PVCS, using a conventional therapeutic duodenoscope If tissue samples were needed, cholangioscopy assisted biopsy or fluoroscopy guided biopsy was performed RESULTS PVCS was advanced into the bile duct in all cases after patients received EST (n = 134 cases), EPBD (n = 2), a combination of EST and EPBD (n = 1), or without treatment of the major papilla (n = 7) Biopsy samples were collected successfully from 112 of 120 cases in which endoscopists considered tissue sampling necessary Endoscopic retrograde cholangiopancreatography (ERCP)/biopsy correctly identified 83 of 96 malignant lesions and 19 of 24 benign lesions (accuracy = 85 0%, sensitivity = 86 5%, specificity = 79 2%, positive predictive value = 94 3%, negative predictive value = 59 4%) Endoscopic retrograde cholangiopancreatography (ERCP)/biopsy plus PVCS correctly identified 95 of 96 malignant lesions and 23 of 24 benign lesions (accuracy = 98 3%, sensitivity = 99 0%, specificity = 95 8%, positive predictive value = 99 0%, negative predictive value = 95 8%) Procedure related complications included pancreatins (4 cases, 2 8%) and cholangitis (6 cases, 43%) CONCLUSIONS PVCS is an accurate diagnostic tool for patients with pancreaticobiliary disorders, resolution was well-defined when combined with biopsy analysis Prospective multicenter clinical trials should evaluate the clinical utility of PVCS in diagnosis of biliary tract diseases