Impact of peroral cholangioscopy on the management of indeterminate biliary conditions: a multicentre prospective trial.
biliary strictures
endoscopic procedures
endoscopic retrograde pancreatography
pancreatic tumours
primary sclerosing cholangitis
Journal
Frontline gastroenterology
ISSN: 2041-4137
Titre abrégé: Frontline Gastroenterol
Pays: England
ID NLM: 101528589
Informations de publication
Date de publication:
Jul 2019
Jul 2019
Historique:
received:
09
03
2018
revised:
10
10
2018
accepted:
18
10
2018
entrez:
9
7
2019
pubmed:
10
7
2019
medline:
10
7
2019
Statut:
ppublish
Résumé
Single-operator cholangioscopy (SOC) can help diagnose biliopancreatic conditions. The impact of SOC on patient outcome has never been specifically addressed. Consecutive patients bearing indeterminate biliary strictures (IDBS), or primary sclerosing cholangitis (PSC) with suspected cholangiocarcinoma, were included. Patients with IDBS had at least one previous inconclusive endoscopic retrograde cholangio pancreatography (ERCP) + cytology. Primary endpoint was the difference in adequacy of management planned before and after SOC with regard to final diagnosis obtained after surgery or 24 months follow-up. Prospective open-label multicentre trial. 61 patients were included (IDBS: 48; PSC: 13); 70.5% had a benign lesion (IDBS 66.7%, PSC 84.6%). The management adequacy rate was significantly higher after SOC than before SOC overall (p<10 Despite a moderate sensitivity for the diagnosis of malignancy, SOC has a dramatic impact on the management of patients with IDBS and PSC with suspected carcinoma. Cholangioscopy might be implemented in the workup of selected patients with challenging diagnosis, when a significant impact on outcome (essentially resection vs conservative management) is to be expected.
Sections du résumé
BACKGROUND AND AIMS
OBJECTIVE
Single-operator cholangioscopy (SOC) can help diagnose biliopancreatic conditions. The impact of SOC on patient outcome has never been specifically addressed.
PATIENTS AND METHODS
METHODS
Consecutive patients bearing indeterminate biliary strictures (IDBS), or primary sclerosing cholangitis (PSC) with suspected cholangiocarcinoma, were included. Patients with IDBS had at least one previous inconclusive endoscopic retrograde cholangio pancreatography (ERCP) + cytology. Primary endpoint was the difference in adequacy of management planned before and after SOC with regard to final diagnosis obtained after surgery or 24 months follow-up.
DESIGN
METHODS
Prospective open-label multicentre trial.
RESULTS
RESULTS
61 patients were included (IDBS: 48; PSC: 13); 70.5% had a benign lesion (IDBS 66.7%, PSC 84.6%). The management adequacy rate was significantly higher after SOC than before SOC overall (p<10
CONCLUSION
CONCLUSIONS
Despite a moderate sensitivity for the diagnosis of malignancy, SOC has a dramatic impact on the management of patients with IDBS and PSC with suspected carcinoma. Cholangioscopy might be implemented in the workup of selected patients with challenging diagnosis, when a significant impact on outcome (essentially resection vs conservative management) is to be expected.
Identifiants
pubmed: 31281624
doi: 10.1136/flgastro-2018-100985
pii: flgastro-2018-100985
pmc: PMC6583565
doi:
Types de publication
Journal Article
Langues
eng
Pagination
236-243Déclaration de conflit d'intérêts
Competing interests: FP, RL and TP have received consultancy fees from Boston Scientific before, during or after the study.
Références
Gastrointest Endosc. 2000 Apr;51(4 Pt 1):383-90
pubmed: 10744806
Gastrointest Endosc. 2000 Nov;52(5):630-4
pubmed: 11060187
Gastrointest Endosc. 2000 Nov;52(5):635-8
pubmed: 11060188
Br J Surg. 2001 Jan;88(1):48-51
pubmed: 11136309
Surgeon. 2003 Feb;1(1):32-8
pubmed: 15568422
Gastrointest Endosc. 2005 Sep;62(3):374-82
pubmed: 16111955
Endoscopy. 2006 Jul;38(7):665-9
pubmed: 16673310
Gastrointest Endosc. 2007 May;65(6):832-41
pubmed: 17466202
Hepatology. 2010 Jan;51(1):174-80
pubmed: 19877179
Clin Gastroenterol Hepatol. 2010 Nov;8(11):934-8
pubmed: 20655394
Gastrointest Endosc. 2011 Sep;74(3):511-9
pubmed: 21737076
Clin Gastroenterol Hepatol. 2012 May;10(5):466-71; quiz e48
pubmed: 22178463
Gastrointest Endosc. 2012 Feb;75(2):347-53
pubmed: 22248602
Gastrointest Endosc. 2013 Feb;77(2):219-26
pubmed: 23231758
Surg Endosc. 2013 May;27(5):1569-72
pubmed: 23233008
J Clin Gastroenterol. 2013 Jul;47(6):532-7
pubmed: 23340062
Gastrointest Endosc. 2013 Dec;78(6):868-874
pubmed: 23800700
Gastroenterology. 2013 Dec;145(6):1215-29
pubmed: 24140396
Dig Liver Dis. 2014 Jun;46(6):518-22
pubmed: 24646882
Gastrointest Endosc. 2015 Jul;82(1):79-87
pubmed: 25841576
Gastrointest Endosc. 2015 Oct;82(4):608-14.e2
pubmed: 26071061
Dig Liver Dis. 2016 Jul;48(7):765-70
pubmed: 27067926
Clin Gastroenterol Hepatol. 2018 Jun;16(6):918-926.e1
pubmed: 29074446
United European Gastroenterol J. 2018 Jul;6(6):902-909
pubmed: 30023068
Scand J Gastroenterol. 1997 Apr;32(4):363-8
pubmed: 9140159