Single-operator cholangioscopy in patients requiring evaluation of bile duct disease or therapy of biliary stones (with videos) - 25/09/11

Doi : 10.1016/j.gie.2011.04.016

Yang K. Chen, MD ^a,^{^{†
Deceased.}}, Mansour A. Parsi, MD ^b, Kenneth F. Binmoeller, MD ^c, Robert H. Hawes, MD ^d, Douglas K. Pleskow, MD ^e, Adam Slivka, MD, PhD ^f, Oleh Haluszka, MD ^g, Bret T. Petersen, MD ^h, Stuart Sherman, MD ⁱ, Jacques Devière, MD, PhD ^j, Søren Meisner, MD ^k, Peter D. Stevens, MD ^l, Guido Costamagna, MD ^m, Thierry Ponchon, MD, PhD ⁿ, Joyce A. Peetermans, PhD ^o, Horst Neuhaus, MD ^p,^⁎
^a Division of Gastroenterology and Hepatology, University of Colorado Health Sciences Center, Denver, Colorado
^b Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio
^c Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California
^d Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina
^e Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
^f Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania
^g Department of Medicine, Fox Chase Cancer Center, Philadelphia, Pennsylvania
^h Department of Gastroenterology, Mayo Clinic, Rochester, Minnesota
ⁱ Gastroenterology and Hepatology Division, Indiana University School of Medicine, Indianapolis, Indiana, USA
^j Service de Gastro-Entérologie et d'Hépato-Pancréatologie, Université Libre de Bruxelles, Hôpital Erasme, Brussels, Belgium
^k H.S. Bispebjerg Hospital, København, Denmark
^l Division of Digestive and Liver Diseases, Columbia-Presbyterian Medical Center, New York, New York, USA
^m U.O. Endoscopia Digestiva Chirurgica, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
ⁿ Service de Gastroentérologie et d'Endoscopie Digestive, Hôpital Edouard Herriot, Lyon, France
^o Endosurgery, Boston Scientific Corp, Natick, Massachusetts, USA
^p Medizinische Klinik, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany

Reprint requests: Horst Neuhaus, MD, Department of Internal Medicine, Evangelisches Krankenhaus Düsseldorf, Kirchfeldstraße 40, D-40217 Düsseldorf, Germany

Riassunto

Background

The feasibility of single-operator cholangioscopy (SOC) for biliary diagnostic and therapeutic procedures was previously reported.

Objective

To confirm the utility of SOC in more widespread clinical use.

Design

Prospective clinical cohort study.

Setting

Fifteen endoscopy referral centers in the United States and Europe.

Patients

Two hundred ninety-seven patients requiring evaluation of bile duct disease or biliary stone therapy.

Interventions

SOC examination and, as indicated, SOC-directed stone therapy or forceps biopsy.

Main Outcome Measurements

Procedural success defined as ability to (1) visualize target lesions and, if indicated, collect biopsy specimens adequate for histological evaluation or (2) visualize biliary stones and initiate fragmentation and removal.

Results

The overall procedure success rate was 89% (95% CI, 84%-92%). Adequate tissue for histological examination was secured in 88% of 140 patients who underwent biopsy. Overall sensitivity in diagnosing malignancy was 78% for SOC visual impression and 49% for SOC-directed biopsy. Sensitivity was higher (84% and 66%, respectively) for intrinsic bile duct malignancies. Diagnostic SOC procedures altered clinical management in 64% of patients. Procedure success was achieved in 92% of 66 patients with stones and complete stone clearance during the study SOC session in 71%. The incidence of serious procedure-related adverse events was 7.5% for diagnostic SOC and 6.1% for SOC-directed stone therapy.

Limitations

The study was observational in design with no control group.

Conclusions

Evaluation of bile duct disease and biliary stone therapy can be safely performed with a high success rate by using the SOC system.

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Abbreviations : EHL, IQR, SOC

Mappa

SOC-directed stone therapy

Discussion

DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: Drs. Chen, Parsi, Binmoeller, Hawes, Pleskow, Slivka, Haluszka, Petersen, Meisner, and Stevens, consultants to Boston Scientific. The other authors disclosed no financial relationships relevant to this publication. Support for this work was provided by Boston Scientific Corp.

Esportazione

Vol 74 - N° 4

P. 805-814 - ottobre 2011 Ritorno al numero

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Single-operator cholangioscopy in patients requiring evaluation of bile duct disease or therapy of biliary stones (with videos) - 25/09/11

Riassunto

Background

Objective

Design

Setting

Patients

Interventions

Main Outcome Measurements

Results

Limitations

Conclusions

Mappa

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