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| Prospective evaluation of the short access cholangioscopy for stone clearance and evaluation of indeterminate strictures |
| Athanasios D Sioulas, Muhammad A El-Masry, Stefan Groth, Guido Schachschal, Mario Anders, Thomas Rosch and Ulrike Denzer |
Hamburg, Germany
Author Affiliations: Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany (Sioulas AD, Groth S, Schachschal G, Anders M, Rösch T and Denzer U); Division of Gastroenterology, Department of Internal Medicine, Assiut University Hospital, Al Walideyah Al Qebleyah, Qesm Than Asyut, Assiut Governorate, Egypt (El-Masry MA)
Corresponding Author: Ulrike Denzer, MD, Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany (Tel: +49-407410-0; Fax: +49-407410-44420; Email: u.denzer@uke.de) |
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Abstract BACKGROUND: Peroral cholangioscopy facilitates diagnosis and therapy of biliary disorders. This study prospectively evaluated a new short access cholangioscopy.
METHODS: Consecutive patients were included as follows: difficult stones (group 1) underwent cholangioscopy with electrohydraulic lithotripsy and indeterminate biliary strictures (group 2) were evaluated with macroscopic assessment and cholangioscopy guided biopsy sampling. We evaluated the complete stone clearance rate (group 1) and diagnostic accuracy (group 2). Follow-up was performed over a median of 13 and 16 months, respectively.
RESULTS: Group 1 (n=21): complete stone clearance defined as lack of stones in cholangiography and stone removal during cholangioscopy was achieved in 15 (71.4%) patients. Clinical stone clearance defined as lack of symptoms, laboratory abnormalities and hospital visits during follow-up, irrespective of stone clearance was evident in 17 (81.0%) patients. One serious adverse event occurred (bile duct perforation). Group 2 (n=28): malignancy was confirmed in 15 patients. Sensitivity, specificity and diagnostic accuracy of cholangioscopy were 85.7%, 75.0% and 80.7%, respectively. Sensitivity, specificity and diagnostic accuracy of biopsies were 54.5%, 100.0% and 72.2%, respectively. No serious adverse events occurred, one patient was lost to follow-up.
CONCLUSIONS: The novel system enabled complex stone treatment and biliary stricture diagnosis. Cholangioscopy outperformed direct biopsy regarding characterization of indeterminate strictures.
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2017, Vol. 16 
