Peroral Cholangioscopy-Guided Forceps Biopsy and Endoscopic Scraper for the Diagnosis of Indeterminate Extrahepatic Biliary Stricture
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Endoscopic Procedure
2.3. Diagnostic Criteria
2.4. Statistical Analysis
3. Results
3.1. Patient’s Characteristics and Baseline Evaluation
3.2. Diagnostic Ability of Trefle® and POCS-Guided Tissue Acquisition for Extrahepatic Cholangiocarcinoma
3.3. Adverse Events
4. Discussion
5. Conclusions
Author Contributions
Conflicts of Interest
References
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Parameter | Biliary Disease (n = 34) |
---|---|
Age (range), years | 71 (47–85) |
Sex, male/female | 19/15 |
Location of stricture (perihilar/distal) | 12/22 |
Malignant | 6/12 |
Benign | 6/10 |
Length of stricture, mm | 16.2 (1.2–46.0) |
Acute cholangitis (presence/absence) | 4/30 |
Total bilirubin, mg/dL | 1.2 (0.3–25.4) |
Tumor marker | |
CEA, ng/mL | |
Malignant | 2.4 (1.2–8.3) |
Benign | 2.2(1.4–4.2) |
CA19-9, U/mL | |
Malignant | 57.9 (0.8–11985) * |
Benign | 7.7 (1.6–71.6) |
Malignant | 18 |
cholangiocarcinoma | 18 |
Benign | 16 |
Benign biliary stricture | 11 |
IgG4-associated sclerosing cholangitis | 1 |
Primary sclerosing cholangitis | 1 |
Intraductal papillary neoplasm of bile duct | 1 |
Bile duct adenoma | 1 |
Peribiliary cyst | 1 |
Trefle® (n = 14) | POCS (n = 20) | p Value | |
---|---|---|---|
Age, years | 70.5 (53–85) | 71 (47–84) | 0.779 *1 |
Sex, male/female | 8/6 | 11/9 | 0.901 *2 |
Malignancy/Benign | 8/6 | 10/10 | 0.681*2 |
Location (perihilar/distal) | 3/11 | 9/11 | 0.293 *2 |
Length of stricture, mm | 18.4 (8.8–42.0) | 16.0 (1.2–46.0) | 0.431 *1 |
Acute cholangitis (presence/absence) | 1/13 | 3/17 | 0.874 *2 |
Total bilirubin, mg/dL | 1.1 (0.6–25.4) | 1.3 (0.3–14.8) | 0.972 *1 |
Tumor marker (serum) | |||
CEA, ng/mL | |||
Malignant | 2.3 (1.2–4.8) | 2.5 (1.4–8.3) | 0.307 *3 |
Benign | 2.0 (1.4–4.2) | 1.9 (1.6–3.1) | 0.609 *3 |
CA19-9, U/mL | |||
Malignant | 76.5 (0.8–11985.0) | 52.5 (17.8–577.6) | 0.271 *3 |
Benign | 7.7 (7.1–13.6) | 7.6 (1.6–71.6) | 0.545 *3 |
Trefle® (n = 14) | POCS (n = 20) | p Value | |
---|---|---|---|
Procedure time, minutes | 92.0 (57–129) | 85.5 (34–170) | 0.766 *1 |
EST or precut papillotomy (previous/with/without) | 1/3/10 | 5/15/0 | <0.001 *2 |
Number of biopsy, times | 2 (1–6) | 3 (2–9) | 0.0498 *1 |
Sensitivity, % | Specificity, % | PPV, % | NPV, % | Accuracy, % | ||
---|---|---|---|---|---|---|
Trefle® | BAC | 87.5 | 100 | 100 | 85.7 | 92.9 |
(7/8) | (6/6) | (7/7) | (6/7) | (13/14) | ||
TB | 62.5 | 83.3 | 83.3 | 62.5 | 71.4 | |
(5/8) | (5/6) | (5/6) | (5/8) | (10/14) | ||
BAC + TB | 87.5 | 83.3 | 87.5 | 83.3 | 85.7 | |
(7/8) | (5/6) | (7/8) | (5/6) | (12/14) | ||
POCS | BAC | 40.0 | 100 | 100 | 60.0 | 68.4 |
(4/10) | (9/9) | (4/4) | (9/15) | (13/19) | ||
PB | 90.0 | 90.0 | 90.0 | 90.0 | 90.0 | |
(9/10) | (9/10) | (9/10) | (9/10) | (18/20) | ||
BAC + PB | 90.0 | 90.0 | 90.0 | 90.0 | 90.0 | |
(9/10) | (9/10) | (9/10) | (9/10) | (18/20) |
Adverse Event | Trefle® (n = 14) | POCS (n = 20) | p Value |
---|---|---|---|
Pancreatitis | 21.4 (3/14) | 15.0 (3/20) | 0.672 |
Bleeding | 0 | 5.0 (1/20) | 1.000 |
Infection | 14.3 (2/14) | 5.0 (1/20) | 0.555 |
Perforation | 0 | 0 | NS |
Cardiac | 0 | 0 | NS |
Pulmonary | 0 | 0 | NS |
Medication reaction | 0 | 0 | NS |
Other | 0 | 0 | NS |
Overall | 35.7 (5/14) | 25.0 (5/20) | 0.704 |
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Kato, M.; Onoyama, T.; Takeda, Y.; Kawata, S.; Kurumi, H.; Koda, H.; Yamashita, T.; Hamamoto, W.; Sakamoto, Y.; Matsumoto, K.; et al. Peroral Cholangioscopy-Guided Forceps Biopsy and Endoscopic Scraper for the Diagnosis of Indeterminate Extrahepatic Biliary Stricture. J. Clin. Med. 2019, 8, 873. https://doi.org/10.3390/jcm8060873
Kato M, Onoyama T, Takeda Y, Kawata S, Kurumi H, Koda H, Yamashita T, Hamamoto W, Sakamoto Y, Matsumoto K, et al. Peroral Cholangioscopy-Guided Forceps Biopsy and Endoscopic Scraper for the Diagnosis of Indeterminate Extrahepatic Biliary Stricture. Journal of Clinical Medicine. 2019; 8(6):873. https://doi.org/10.3390/jcm8060873
Chicago/Turabian StyleKato, Masayuki, Takumi Onoyama, Yohei Takeda, Soichiro Kawata, Hiroki Kurumi, Hiroki Koda, Taro Yamashita, Wataru Hamamoto, Yuri Sakamoto, Kazuya Matsumoto, and et al. 2019. "Peroral Cholangioscopy-Guided Forceps Biopsy and Endoscopic Scraper for the Diagnosis of Indeterminate Extrahepatic Biliary Stricture" Journal of Clinical Medicine 8, no. 6: 873. https://doi.org/10.3390/jcm8060873
APA StyleKato, M., Onoyama, T., Takeda, Y., Kawata, S., Kurumi, H., Koda, H., Yamashita, T., Hamamoto, W., Sakamoto, Y., Matsumoto, K., & Isomoto, H. (2019). Peroral Cholangioscopy-Guided Forceps Biopsy and Endoscopic Scraper for the Diagnosis of Indeterminate Extrahepatic Biliary Stricture. Journal of Clinical Medicine, 8(6), 873. https://doi.org/10.3390/jcm8060873