Probe-based confocal laser endomicroscopy in the evaluation of dominant strictures in patients with primary sclerosing cholangitis: results of a U.S. multicenter prospective trial - 17/08/21
Abstract |
Background and Aims |
Patients with primary sclerosing cholangitis (PSC) and dominant biliary strictures carry increased risk for the development of cholangiocarcinoma. Although ERCP-based techniques including brush cytology and intraductal biopsy sampling represent first-line tissue sampling methods for dominant strictures, sensitivity is low. Probe-based confocal laser endomicroscopy (pCLE) offers microscopic-level imaging of subepithelial biliary mucosa. Because data regarding the use of pCLE in PSC are limited, we aimed to investigate its diagnostic performance in dominant strictures.
Methods |
This was a multicenter prospective study involving PSC patients with dominant strictures. ERCP with pCLE was performed with use of the Miami classification (2+ criteria for malignant diagnosis) and Paris classification. Final malignant diagnoses required histopathologic confirmation, and benign diagnoses required a minimum of 1 year of follow-up without development of cancer.
Results |
Fifty-nine patients (mean age, 49 years; 59% men) with 63 strictures were included in the study. Stricture locations included the common bile duct (31.7%), bifurcation (22.2%), and common hepatic duct (19%). Seven patients (11.9%) were found to have cholangiocarcinoma. The sensitivity and specificity of pCLE was 85.7% (95% confidence interval [CI], 42.1-99.6) and 73.1% (95% CI, 58.9-84.4), respectively. Within specific stricture locations, the highest sensitivity was seen at the bifurcation (100%; 95% CI, 2.5-100) and the right hepatic duct (100%; 95% CI, 29.2-100). The lowest sensitivities were seen at the common bile duct (25%; 95% CI, 5.5-57.2) and the left hepatic duct (28.6%; 95% CI, 3.7-70.9).
Conclusions |
In this prospective multicenter study, pCLE had a high sensitivity in detecting cholangiocarcinoma, but technical aspects of the probe may limit evaluation in the common bile duct and left hepatic duct. Further evaluation is needed to elucidate the role of pCLE in the algorithm of excluding neoplasia in biliary strictures associated with PSC. (Clinical trial registration number: NCT02736708.)
Le texte complet de cet article est disponible en PDF.Abbreviations : FISH, pCLE, PSC, SD
Plan
| DISCLOSURE: The following authors disclosed financial relationships: M. Kahaleh: Consultant for Boston Scientific, Concordia Laboratories, Inc, Abbvie, and Erbe; research support from Boston Scientific, Apollo Endosurgery, Cook Endoscopy, ASPIRE Bariatrics, NinePoint Medical, Olympus, Merit Medical, and Interscope Med. R. Z. Sharaiha: Consultant for Boston Scientific Olympus, and Cook Endoscopy. A. Slivka: Research support from Boston Scientific and Olympus. D. V. Sejpal, A. Sethi: Consultant for Boston Scientific, Medtronic, Micro-Tech, Intuit, and Olympus; travel reimbursement from Creo. R. J. Shah: Consultant for Boston Scientific, Olympus, and Cook Endoscopy; advisory board for Boston Scientific. All other authors disclosed no financial relationships. Research support for this study (Raj J. Shah) was provided by an unrestricted educational grant to the University of Colorado Anschutz Medical Campus by Mauna Kea Technologies. |
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| If you would like to chat with an author of this article, you may contact Dr Shah at [email protected]. |
Vol 94 - N° 3
P. 569 - septembre 2021 Retour au numéro
Article précédent
- Role of fluorescence confocal microscopy for rapid evaluation of EUS fine-needle biopsy sampling in pancreatic solid lesions
- Serena Stigliano, Anna Crescenzi, Chiara Taffon, Francesco Covotta, Cesare Hassan, Giulio Antonelli, Martina Verri, Dario Biasutto, Roberto Mario Scarpa, Francesco Maria Di Matteo
- Probe-based confocal laser endoscopy and primary sclerosing cholangitis: Is seeing actually believing?
- Mark Benson, Patrick Pfau
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