4.5 Review

Endoscopic evaluation of indeterminate biliary strictures: Cholangioscopy, endoscopic ultrasound, or both?

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Identification of patients with malignant biliary strictures using a cholangioscopy-based deep learning artificial intelligence (with video)

Neil B. Marya et al.

Summary: A convolutional neural network (CNN) model developed solely using cholangioscopy images has been found to have greater accuracy for classifying biliary strictures compared to traditional ERCP-based sampling techniques. The CNN showed good performance in mimicking expert annotations of high-quality malignant images, and its overall accuracy in video analysis was significantly higher than brush cytology or forceps biopsy sampling. The study also identified common image features associated with malignant biliary strictures.

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A real-time interpretable artificial intelligence model for the cholangioscopic diagnosis of malignant biliary stricture (with videos)

Xiang Zhang et al.

Summary: This study developed a real-time interpretable AI system called MBSDeiT to predict malignant biliary strictures under digital single-operator cholangioscopy (DSOC). MBSDeiT accurately identified qualified images and predicted MBSs with superior performance compared to expert and novice endoscopists. The AI predictions were significantly associated with specific endoscopic features, increasing the interpretability of the system.

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Digital Single-operator Cholangioscopy (DSOC) Improves Interobserver Agreement (IOA) and Accuracy for Evaluation of Indeterminate Biliary Strictures The Monaco Classification

Amrita Sethi et al.

Summary: The aim of this study was to define terminology for visual diagnosis of biliary lesions and develop a model for optimizing the diagnostic performance of digital single-operator cholangioscopy (DSOC). The study identified 8 visual criteria for biliary lesions using the Monaco Classification and found improved interobserver agreement and diagnostic accuracy rates for DSOC.

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Identification of endoscopic predictors of biliary malignancy during digital cholangioscopy

Hicham El Bacha et al.

Summary: This study identified four cholangioscopic features associated with malignancy in indeterminate biliary strictures. These features can be easily implemented in clinical practice and have the potential to increase diagnostic confidence during the workup of indeterminate biliary strictures.

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Digital Cholangioscopic Interpretation: When North Meets the South

Michel Kahaleh et al.

Summary: The interrater agreement and accuracy rate of DSOC using visual criteria from both Monaco Criteria and CRM are similar. However, some criteria from both sets suffer from poor IA, thus affecting the overall diagnostic accuracy. More formal training and refinements in visual criteria with additional validation are needed to improve diagnostic accuracy.

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Artificial intelligence for automatic diagnosis of biliary stricture malignancy status in single-operator cholangioscopy: a pilot study

Miguel Mascarenhas Saraiva et al.

Summary: The study developed a CNN-based system for automatic detection of malignant biliary strictures in DSOC images. The system showed high accuracy, sensitivity, and specificity in cross-validation analysis, indicating that the introduction of artificial intelligence algorithms can significantly improve the diagnostic yield for malignant strictures in DSOC systems.

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Digital single-operator cholangioscopy interobserver study using a new classification: the Mendoza Classification (with video)

Michel Kahaleh et al.

Summary: The use of digital single-operator cholangioscopy (DSOC) with newly refined criteria has shown a significant increase in diagnostic accuracy and interobserver agreement (IOA) compared to previous criteria. The reference atlas aids in training and improves diagnostic accuracy for DSOC.

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Needle tract seeding after endoscopic ultrasound-guided tissue acquisition of pancreatic tumors: Nationwide survey in Japan

Masayuki Kitano et al.

Summary: This study investigated the current status of needle tract seeding (NTS) after endoscopic ultrasound-guided tissue acquisition (EUS-TA) of pancreatic tumors. The results showed that the NTS rate was significantly higher in patients with pancreatic ductal adenocarcinomas (PDACs) than in those with other tumors, and NTS was observed more frequently in patients who underwent transgastric EUS-TA. For PDAC patients with NTS, timely resection could prolong their survival.

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Clinical impact of a novel device delivery system in the diagnosis of bile duct lesions: A single-center experience

Tomoaki Matsumori et al.

Summary: This study evaluated the feasibility, utility, and safety of a novel device delivery system for bile duct biopsy. The results showed that the system had a high technical success rate and adequate tissue sampling rate, and demonstrated good diagnostic sensitivity, specificity, and accuracy in diagnosing biliary strictures.

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Diagnostic performance of digital and video cholangioscopes in patients with suspected malignant biliary strictures: a systematic review and meta-analysis

Santi Kulpatcharapong et al.

Summary: Digital/video per-oral cholangioscopy has high diagnostic performance for diagnosing malignant biliary strictures. While image diagnosis offers higher sensitivity than biopsy, its specificity decreases as a trade-off.

SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES (2022)

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Consensus guidelines on the role of cholangioscopy to diagnose indeterminate biliary stricture

Phonthep Angsuwatcharakon et al.

Summary: This study aims to develop a consensus statement regarding the clinical role of cholangioscopy in the diagnosis of indeterminate biliary strictures. Nine final statements were formulated by international experts, which suggest that cholangioscopy has an adjunct role to evaluate and diagnose indeterminate biliary strictures.
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Comparison of tube-assisted mapping biopsy with digital single-operator peroral cholangioscopy for preoperative evaluation of biliary tract cancer

Tsuyoshi Takeda et al.

Summary: This study retrospectively examined the application of digital single-operator cholangioscopy-guided mapping biopsy and tube-assisted mapping biopsy in the preoperative evaluation of biliary tract cancer. The results showed similar technical success rates for both techniques, but low adequate tissue acquisition rates. Experts demonstrated better diagnostic performance, and tube-assisted mapping biopsy may be a feasible option when expertise for digital single-operator cholangioscopy is limited.

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Histological assessment of new cholangioscopy-guided forceps in ERCP biliary stricture sampling: a blinded comparative study

Eric J. Vargas et al.

Summary: This study analyzed the specimen quality of single-operator cholangioscopy (SOC)-guided biopsies and compared new generation forceps with prior legacy forceps. The results showed a high rate of crush artifact in SOC-guided biopsy specimens, indicating the need for further investigation into proper biopsy technique and handling to improve diagnostic yield.

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Comparison of fine-needle aspiration and fine-needle biopsy devices for endoscopic ultrasound-guided sampling of solid lesions: a systemic review and meta-analysis

Priscilla A. van Riet et al.

Summary: The meta-analyses showed that fine-needle biopsy (FNB) outperformed fine-needle aspiration (FNA) in obtaining tissue samples, with higher diagnostic accuracy and tissue core rate, and requiring fewer passes for diagnosis. Among different FNB devices, forward-facing bevel needles demonstrated higher diagnostic accuracy compared to reverse bevel needles. However, due to low quality of evidence, further research is needed to make strong recommendations on the optimal FNB design.

ENDOSCOPY (2021)

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Diagnostic accuracy and interobserver agreement of digital single-operator cholangioscopy for indeterminate biliary strictures

Pauline M. C. Stassen et al.

Summary: The study found that d-SOC had low sensitivity and specificity for visually appraising indeterminate biliary strictures, with significant interobserver variation. Although reaching a consensus on the optical features of biliary strictures remains important, optimizing visually directed biopsy sampling may be the most important role of cholangioscopy in biliary stricture assessment.

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Single-operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate biliary strictures: a systematic review

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Arjun Nanda et al.

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Hauke S. Heinzow et al.

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