Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Direct Single Operator Cholangioscopy and Intraductal Ultrasonography in Patients with Indeterminate Biliary Strictures: A Single Center Experience

Version 1 : Received: 15 May 2024 / Approved: 15 May 2024 / Online: 16 May 2024 (04:32:57 CEST)

How to cite: Sacco, M.; Gesualdo, M.; Staiano, M. T.; Dall'Amico, E.; Caronna, S.; Dibitetto, S.; Canalis, C.; Caneglias, A.; Mediati, F.; Stasio, R. C.; Gaia, S.; Saracco, G. M.; Bruno, M.; De Angelis, C. G. Direct Single Operator Cholangioscopy and Intraductal Ultrasonography in Patients with Indeterminate Biliary Strictures: A Single Center Experience. Preprints 2024, 2024051031. https://doi.org/10.20944/preprints202405.1031.v1 Sacco, M.; Gesualdo, M.; Staiano, M. T.; Dall'Amico, E.; Caronna, S.; Dibitetto, S.; Canalis, C.; Caneglias, A.; Mediati, F.; Stasio, R. C.; Gaia, S.; Saracco, G. M.; Bruno, M.; De Angelis, C. G. Direct Single Operator Cholangioscopy and Intraductal Ultrasonography in Patients with Indeterminate Biliary Strictures: A Single Center Experience. Preprints 2024, 2024051031. https://doi.org/10.20944/preprints202405.1031.v1

Abstract

Evaluation of biliary strictures remains a challenge due to the low sensitivity of standard diagnostic work up, but the introduction of direct single-operator cholangioscopy (DSOC) changed this paradigm. Aim of our study was to evaluate diagnostic performance of DSOC and DSOC-targeted biopsies, intraductal ultrasound (IDUS) and brush cytology in patients with indeterminate biliary stricture (IBS). We evaluated patients who underwent advanced diagnostic work up for IBS in our endoscopy unit from ‘01/2018 to ‘12/2022; all patients had at least one previous attempt to characterize the biliary stricture. Final diagnosis was based on surgical pathology and/or clinical and radiological follow-up of at least 12 months. A total of 57 patients with a mean age of 67.2 ± 10.0 years were included, with a mean follow up of 18.2 ± 18.1 months. IBS were mostly located in the distal common bile duct (45.6%) and final diagnosis was consistent with malignancy in 35 patients (61.4%). DSOC and IDUS showed a significantly higher accuracy (89.5% and 82.7% respectively) compared to standard cytology (61.5%, p <0.05). In our experience, DSOC visualization and IDUS both demonstrated an optimal diagnostic yield in the differentiation of IBS, with an acceptable safety profile both quantitatively and qualitatively.

Keywords

cholangioscopy; indeterminate biliary stricture; ERCP; IDUS; biliary stenosis; cholangiocarcinoma

Subject

Medicine and Pharmacology, Gastroenterology and Hepatology

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