Diagnostic utility of single-user peroral cholangioscopy in sclerosing cholangitis

Abstract

Objective. To evaluate the diagnostic utility of single-operator peroral cholangioscopy (SOC) in patients with sclerosing cholangitis. Methods. All patients with sclerosing cholangitis who underwent SOC procedures due to suspicious biliary strictures, in one Swedish and four UK tertiary centers in 2008–2012, were retrospectively enrolled. For each SOC procedure in sclerosing cholangitis, another one attempted due to a single biliary stricture in the same center and calendar year was randomly selected as control. Patients were followed up until death or last clinic visit until November 2012. Results. Fifty-four SOC procedures were attempted in 52 sclerosing cholangitis patients (48 with primary sclerosing cholangitis, 4 with IgG4-related sclerosing cholangitis). Cannulation with the SOC system failed more frequently in sclerosing cholangitis (15% vs. 2% in controls; p = 0.015). The sensitivity, specificity, and accuracy of SOC (including tissue sampling) for cancer diagnosis were similar in sclerosing cholangitis and controls (50% vs. 55%, 100% vs. 97%, and 88% vs. 80%, respectively) with largely overlapping confidence intervals. Adverse events were more common in sclerosing cholangitis, due to an increased frequency of cholangitis (11% vs. 2% in controls; p = 0.051). Conclusions. SOC is equally accurate in cancer diagnosis in sclerosing cholangitis and patients with single biliary strictures. However, cholangioscope insertion may be hampered by bile duct narrowing and post-SOC cholangitis is more common in sclerosing cholangitis.

Key Words::

• cholangiocarcinoma
• cholangioscopy
• endoscopic retrograde cholangiopancreatography
• IgG4-related sclerosing cholangitis
• primary sclerosing cholangitis

Declaration of interest: G.J. Webster has been a member of the UK Advisory Board for Boston Scientific Inc. His unit at University College Hospital, London, has received financial support and educational materials for teaching courses. R. Sturgess is on the advisory board of Boston Scientific Inc. and Olympus. D. Westaby and K. Oppong are on the advisory board of Boston Scientific Inc. For the remaining authors there are no conflicts of interest.

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