Feasibility of Peroral Cholangioscopy in the Initial Endoscopic Retrograde Cholangiopancreatography for Malignant Biliary Strictures

Overview

Journal Diagnostics (Basel)

Specialty Radiology

Date 2024 Nov 27

PMID 39594255

Authors

Yuichi Suzuki

Tomohiro Ishii

Haruo Miwa

Takeshi Sato

Yoshihiro Goda

Kuniyasu Irie

Kazuya Sugimori

Shin Maeda

Affiliations

Soon will be listed here.

Abstract

Peroral cholangioscopy (POCS) is valuable for assessing malignant biliary strictures; however, biliary drainage prior to POCS often hinders accurate diagnosis. This retrospective study aimed to investigate the feasibility of POCS using a newly developed cholangioscope, CHF-B290, during initial endoscopic retrograde cholangiopancreatography (ERCP) for malignant biliary strictures. This multicenter retrospective study included patients who underwent initial ERCP for malignant biliary strictures at two institutions between January 2018 and March 2022. Patients who underwent initial ERCP with POCS were classified into the POCS group, and those without POCS were classified into the non-POCS group. To prevent post-POCS cholangitis, the original irrigation system for CHF-B290 was used in all POCS examinations. The primary endpoint was the rate of post-ERCP biliary infections, and the secondary endpoints were other ERCP-related complications, including pancreatitis, bleeding, and perforation. Overall, 53 and 94 patients were included in the POCS and non-POCS groups, respectively. For the primary endpoint, the rate of post-ERCP biliary infection was not significantly different between the two groups (1.9% vs. 5.3%, = 0.42). For the secondary endpoints, no significant differences were observed in the rates of post-ERCP pancreatitis (5.7% vs. 6.4%, = 1.00) and other ERCP-related complications. The overall complication rate was 9.4% in the POCS group and 13% in the non-POCS group ( = 0.60). POCS during the initial ERCP for malignant biliary strictures is feasible.

References

Shah R, Raijman I, Brauer B, Gumustop B, Pleskow D . Performance of a fully disposable, digital, single-operator cholangiopancreatoscope. Endoscopy. 2017; 49(7):651-658. DOI: 10.1055/s-0043-106295. View

Gerges C, Beyna T, Tang R, Bahin F, Lau J, van Geenen E . Digital single-operator peroral cholangioscopy-guided biopsy sampling versus ERCP-guided brushing for indeterminate biliary strictures: a prospective, randomized, multicenter trial (with video). Gastrointest Endosc. 2019; 91(5):1105-1113. DOI: 10.1016/j.gie.2019.11.025. View

Ghersi S, Fuccio L, Bassi M, Fabbri C, Cennamo V . Current status of peroral cholangioscopy in biliary tract diseases. World J Gastrointest Endosc. 2015; 7(5):510-7. PMC: 4436918. DOI: 10.4253/wjge.v7.i5.510. View

Hammerle C, Haider S, Chung M, Pandey A, Smith I, Kahaleh M . Endoscopic retrograde cholangiopancreatography complications in the era of cholangioscopy: is there an increased risk?. Dig Liver Dis. 2012; 44(9):754-8. DOI: 10.1016/j.dld.2012.04.024. View

Ishida Y, Itoi T, Okabe Y . Types of Peroral Cholangioscopy: How to Choose the Most Suitable Type of Cholangioscopy. Curr Treat Options Gastroenterol. 2016; 14(2):210-9. DOI: 10.1007/s11938-016-0090-2. View

Cotton P, Lehman G, Vennes J, GEENEN J, Russell R, Meyers W . Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991; 37(3):383-93. DOI: 10.1016/s0016-5107(91)70740-2. View

Angsuwatcharakon P, Kulpatcharapong S, Moon J, Ramchandani M, Lau J, Isayama H . Consensus guidelines on the role of cholangioscopy to diagnose indeterminate biliary stricture. HPB (Oxford). 2021; 24(1):17-29. DOI: 10.1016/j.hpb.2021.05.005. View

Ishii T, Kaneko T, Murakami A, Enomoto M, Sugimori K, Kawana I . Cholangioscopy in IgG4-related sclerosing cholangitis using texture and color enhancement imaging and red dichromatic imaging. Endoscopy. 2023; 55(S 01):E1019-E1020. PMC: 10468263. DOI: 10.1055/a-2155-4853. View

Yokoe M, Hata J, Takada T, Strasberg S, Asbun H, Wakabayashi G . Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2017; 25(1):41-54. DOI: 10.1002/jhbp.515. View

10.

Navaneethan U, Lourdusamy D, Gutierrez N, Zhu X, Vargo J, Parsi M . New approach to decrease post-ERCP adverse events in patients with primary sclerosing cholangitis. Endosc Int Open. 2017; 5(8):E710-E717. PMC: 5546902. DOI: 10.1055/s-0043-102398. View

11.

Sethi A, Chen Y, Austin G, Brown W, Brauer B, Fukami N . ERCP with cholangiopancreatoscopy may be associated with higher rates of complications than ERCP alone: a single-center experience. Gastrointest Endosc. 2010; 73(2):251-6. DOI: 10.1016/j.gie.2010.08.058. View

12.

Mandai K, Uno K, Yasuda K . Gastrointestinal: Plastic stent-induced polyp-like lesion in the bile duct. J Gastroenterol Hepatol. 2020; 35(12):2031. DOI: 10.1111/jgh.15092. View

13.

Liao W, Angsuwatcharakon P, Isayama H, Dhir V, Devereaux B, Khor C . International consensus recommendations for difficult biliary access. Gastrointest Endosc. 2016; 85(2):295-304. DOI: 10.1016/j.gie.2016.09.037. View

14.

Bernica J, Elhanafi S, Kalakota N, Jia Y, Dodoo C, Dwivedi A . Cholangioscopy Is Safe and Feasible in Elderly Patients. Clin Gastroenterol Hepatol. 2018; 16(8):1293-1299.e2. DOI: 10.1016/j.cgh.2018.02.032. View

15.

Thosani N, Zubarik R, Kochar R, Kothari S, Sardana N, Nguyen T . Prospective evaluation of bacteremia rates and infectious complications among patients undergoing single-operator choledochoscopy during ERCP. Endoscopy. 2016; 48(5):424-31. DOI: 10.1055/s-0042-101407. View

16.

Murabayashi T, Ogawa T, Koshita S, Kanno Y, Kusunose H, Sakai T . Peroral Cholangioscopy-guided Electrohydraulic Lithotripsy with a SpyGlass DS Versus a Conventional Digital Cholangioscope for Difficult Bile Duct Stones. Intern Med. 2020; 59(16):1925-1930. PMC: 7492117. DOI: 10.2169/internalmedicine.4463-20. View

17.

Woo Y, Lee J, Oh S, Kim M, Jung J, Lee K . Role of SpyGlass peroral cholangioscopy in the evaluation of indeterminate biliary lesions. Dig Dis Sci. 2014; 59(10):2565-70. DOI: 10.1007/s10620-014-3171-x. View

18.

de Vries A, van der Heide F, Ter Steege R, Koornstra J, Buddingh K, Gouw A . Limited diagnostic accuracy and clinical impact of single-operator peroral cholangioscopy for indeterminate biliary strictures. Endoscopy. 2019; 52(2):107-114. DOI: 10.1055/a-1061-7067. View

19.

Kanno Y, Koshita S, Ogawa T, Masu K, Kusunose H, Sakai T . Peroral cholangioscopy by SpyGlass DS versus CHF-B260 for evaluation of the lateral spread of extrahepatic cholangiocarcinoma. Endosc Int Open. 2018; 6(11):E1349-E1354. PMC: 6221821. DOI: 10.1055/a-0743-5283. View

20.

Kanda Y . [Statistical analysis using freely-available "EZR (Easy R)" software]. Rinsho Ketsueki. 2015; 56(10):2258-66. DOI: 10.11406/rinketsu.56.2258. View