CHOLANGIOSCOPIC CRITERIA FOR INDETERMINATE BILIARY STENOSIS DIAGNOSIS

Aims:

Single-operator cholangioscopy (SOC) has been a major advance in indeterminate biliary stricture (IDBS) diagnosis because it has made direct visualization and optically guided biopsy of these lesions. However, SOC-guided biopsies have shown limited sensitivity. In order to overcome this limitation, identifying the cholangioscopic features that most strongly suggest malignancy is an interesting way to improve SOC diagnostic capabilities; however, no systematic analysis of SOC findings has been conducted to date.

The aim of our study is to establish endoscopic criteria allowing to distinguish between benign and malignant lesions.

Methods:

4 referral centers included 98 Spyglass DS cholangioscopy recordings performed for indeterminate biliary strictures (IDBS) whose final diagnosis was known by histology or follow-up for more than 1 year. 7 experts in cholangioscopy participated in the development of a consensual reading grouping 20 semiological criteria. The videos were analyzed individually by each expert after randomization according to the reading grid. A hypothesis diagnosis was issued for each examination. After a statistic analysis a second meeting with the same methodology were held for criteria validation.

Results:

98 IDBS videos from 95 patients of mean age 66 years (13 – 89) were analyzed; there were 38 benign and 60 malignant strictures. The Sensitivity ranged from 68% to 81% and specificity from 55 to 71%. The univariate and multivariate analysis identified 4 significant criteria. One for benign lesions: the presence of endobiliary material odds ratio (OR)= 0.649; 95% confidence interval (CI), 0.427 – 0.988. Three for malignant lesions: villous pattern OR = 1.477; 95% CI, 0.98 – 2.21; irregular vessels OR = 2.042; 95% CI, 1.35 – 3.08; redish aspect OR = 1.67; 95% CI,1.09 – 2.53.

Conclusions:

Simple criteria's could assist malignancy diagnosis and enhance The performance of cholangioscopic visual diagnosis of IDBS.