Diagnostic Yield Of Probe-Based Confocal Laser Endomicroscopy (PCLE) In Biliary Stricture Of Undefined Origin

Aims Biliary strictures often represent a diagnostic challenge. Their nature can be investigated with trans-papillary brushing and biopsies, cholangiography, cholangioscopy-guided biopsies, EUS-FNA and intraductal ultrasound (IDUS) but none of these thecniques has an optimal diagnostic yield. Probe-based Confocal Laser Endomicroscopy (pCLE) is a promising tool in this setting. Our aim was to evaluate the diagnostic value of pCLE in detecting malignant biliary strictures.

Methods We enrolled patients with biliary strictures who underwent ERCP + pCLE in our Center from March to November 2019. All procedures were performed by a single operator. The pCLE procedure was recorded and reviewed afterwards by the same operator. The final diagnosis was based on histology (biopsies or surgical report) or on a follow-up of at least 12 months.

Results 9 patients (4 males, 5 females), aged from 47 to 83 years (median age 63) were included. 3 strictures were in common bile duct, 6 in common hepatic duct; the length varied between 9 and 25 mm (median length 16 mm). 4 out of 9 patients had undergone a previous ERCP, with unrevealing biopsies or brushing; in all case a biliary stent had been left in place. 7 patients received a final diagnosis of malignant stricture and 2 of benign one. pCLE recognized malignancy in 6 out of 7 cases and a benign lesion in 1 out of 2 cases. The only case with a false-positive pCLE had undergone a previous biliary stenting. Sensitivity was 86 %, specificity 50 %, PPV 86 %, NPV 50 % and accuracy 78 %.

Conclusions pCLE showed a good diagnostic yield and can be helpful in patients with undefined biliary strictures, potentially reducing delays in diagnosis and expensive reiteration of endoscopic procedures. Larger studies are needed to assess its value in this scenario and the interobserver agreement. High costs and a long learning curve are the foreseen main limitations.

Citation Rizzi F, Bruno M, Sacco M et al. eP330 DIAGNOSTIC YIELD OF PROBE-BASED CONFOCAL LASER ENDOMICROSCOPY (PCLE) IN BILIARY STRICTURE OF UNDEFINED ORIGIN. Endoscopy 2021; 53: S205.

Publication History

Article published online:
19 March 2021