Comparison of the diagnostic accuracy of peroral video-cholangioscopic visual findings and cholangioscopy-guided forceps biopsy findings for indeterminate biliary lesions: a prospective study

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• 作者：Takao Nishikawa ; MD¹ ; Toshio Tsuyuguchi ; MD ; PhD¹ ; ; Yuji Sakai ; MD ; PhD¹ ; Harutoshi Sugiyama ; MD ; PhD¹ ; Masaru Miyazaki ; MD ; PhD² ; Osamu Yokosuka ; MD ; PhD¹
• 关键词：ERC ; endoscopic retrograde cholangiography ; PVCS ; peroral video-cholangioscopy
• 刊名：Gastrointestinal Endoscopy
• 出版年：2013
• 出版时间：February, 2013
• 年：2013
• 卷：77
• 期：2
• 页码：219-226
• 全文大小：3557 K

文摘

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Background

The diagnostic accuracy of peroral video-cholangioscopy for indeterminate biliary lesions has not been determined in a prospective study.

Objective

To evaluate and compare the diagnostic accuracy of the peroral video-cholangioscopic visual findings for indeterminate biliary lesions with that of the cholangioscopy-guided forceps biopsy findings.

Design

Prospective cohort study.

Setting

Tertiary-care referral center.

Patients

Patients who showed indeterminate biliary lesions on endoscopic retrograde cholangiography underwent peroral video-cholangioscopy for diagnosis.

Intervention

Each patient underwent peroral video-cholangioscopy with cholangioscopy-guided forceps biopsy.

Main Outcome Measurements

The accuracy of diagnosis by the peroral video-cholangioscopic visual findings and cholangioscopy-guided forceps biopsy findings compared with that of the final diagnosis by other methods (malignant or benign).

Results

Thirty-three patients were enrolled, and the final diagnoses revealed that the lesions were malignant in 21 patients. All procedures were technically successful, and fine views were obtained in all patients. Procedure-related complications occurred in 2 patients (6.1 % ), but these complications were mild. The sensitivity, specificity, and accuracy were 100 % , 91.7 % , and 97.0 % , respectively, for the peroral video-cholangioscopic visual findings and 38.1 % , 100 % , and 60.6 % , respectively, for the cholangioscopy-guided forceps biopsy findings, and a significant difference was observed in the accuracy (P = .0018).

Limitations

This was not a blinded study. No comparison was made with other diagnostic modalities involving tissue sampling.

Conclusion

The diagnostic accuracy of the peroral video-cholangioscopic visual findings for indeterminate biliary lesions was excellent and significantly higher than that of the cholangioscopy-guided forceps biopsy findings. The accuracy of the cholangioscopy-guided forceps biopsy was insufficient, but the technique had an excellent specificity.