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Lin TY, Chen CC, Kuo YT, Liao WC. Endoscopic and novel approaches for evaluation of indeterminate biliary strictures. J Formos Med Assoc 2025:S0929-6646(25)00266-9. [PMID: 40425411 DOI: 10.1016/j.jfma.2025.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 05/13/2025] [Accepted: 05/23/2025] [Indexed: 05/29/2025] Open
Abstract
Indeterminate biliary strictures are defined as strictures which evade definitive diagnosis after endoscopic retrograde cholangiopancreatography (ERCP)-assisted sampling with brush cytology and/or forceps biopsy and pose significant clinical challenges. While most indeterminate biliary strictures are attributed to malignancies, up to one-third are benign strictures. False-negative and false-positive diagnoses lead to delayed or inappropriate treatment with untoward clinical consequences. Peroral cholangioscopy (POC) and single-operator cholangioscopy (SOC) have demonstrated superior diagnostic accuracy over traditional ERCP-based techniques through enhanced visualization and targeted biopsy. Endoscopic ultrasound (EUS)-guided tissue sampling also achieves superior sensitivity and diagnostic accuracy compared with ERCP-based tissue sampling. The 2025 ESGE guideline proposes an algorithm for optimizing the utilization of ERCP-based and EUS-guided tissue sampling and cholangioscopy with consideration of the stricture location. Furthermore, molecular diagnostic tools such as fluorescence in situ hybridization (FISH) and next-generation sequencing (NGS) enable the detection of chromosomal and genetic alterations commonly associated with biliary malignancies, thereby enhancing the sensitivity for malignancy. This review summarizes recent advances in the diagnostic work-up of indeterminate biliary strictures and emerging diagnostic strategies and modalities.
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Affiliation(s)
- Tung-Yen Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chieh-Chang Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Ting Kuo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Division of Endoscopy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
| | - Wei-Chih Liao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Endoscopy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
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Araújo CC, Frias J, Mendes F, Martins M, Mota J, Almeida MJ, Ribeiro T, Macedo G, Mascarenhas M. Unlocking the Potential of AI in EUS and ERCP: A Narrative Review for Pancreaticobiliary Disease. Cancers (Basel) 2025; 17:1132. [PMID: 40227709 PMCID: PMC11988021 DOI: 10.3390/cancers17071132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2025] [Revised: 02/14/2025] [Accepted: 03/03/2025] [Indexed: 04/15/2025] Open
Abstract
Artificial Intelligence (AI) is transforming pancreaticobiliary endoscopy by enhancing diagnostic accuracy, procedural efficiency, and clinical outcomes. This narrative review explores AI's applications in endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP), emphasizing its potential to address diagnostic and therapeutic challenges in pancreaticobiliary diseases. In EUS, AI improves pancreatic mass differentiation, malignancy prediction, and landmark recognition, demonstrating high diagnostic accuracy and outperforming traditional guidelines. In ERCP, AI facilitates precise biliary stricture identification, optimizes procedural techniques, and supports decision-making through real-time data integration, improving ampulla recognition and predicting cannulation difficulty. Additionally, predictive analytics help mitigate complications like post-ERCP pancreatitis. The future of AI in pancreaticobiliary endoscopy lies in multimodal data fusion, integrating imaging, genomic, and molecular data to enable personalized medicine. However, challenges such as data quality, external validation, clinician training, and ethical concerns-like data privacy and algorithmic bias-must be addressed to ensure safe implementation. By overcoming these challenges, AI has the potential to redefine pancreaticobiliary healthcare, improving diagnostic accuracy, therapeutic outcomes, and personalized care.
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Affiliation(s)
- Catarina Cardoso Araújo
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (C.C.A.); (J.F.); (F.M.); (M.M.); (J.M.); (M.J.A.); (T.R.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Joana Frias
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (C.C.A.); (J.F.); (F.M.); (M.M.); (J.M.); (M.J.A.); (T.R.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Francisco Mendes
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (C.C.A.); (J.F.); (F.M.); (M.M.); (J.M.); (M.J.A.); (T.R.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Miguel Martins
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (C.C.A.); (J.F.); (F.M.); (M.M.); (J.M.); (M.J.A.); (T.R.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Joana Mota
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (C.C.A.); (J.F.); (F.M.); (M.M.); (J.M.); (M.J.A.); (T.R.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Maria João Almeida
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (C.C.A.); (J.F.); (F.M.); (M.M.); (J.M.); (M.J.A.); (T.R.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Tiago Ribeiro
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (C.C.A.); (J.F.); (F.M.); (M.M.); (J.M.); (M.J.A.); (T.R.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Guilherme Macedo
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (C.C.A.); (J.F.); (F.M.); (M.M.); (J.M.); (M.J.A.); (T.R.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Miguel Mascarenhas
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal; (C.C.A.); (J.F.); (F.M.); (M.M.); (J.M.); (M.J.A.); (T.R.); (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
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Mascarenhas M, Almeida MJ, González-Haba M, Castillo BA, Widmer J, Costa A, Fazel Y, Ribeiro T, Mendes F, Martins M, Afonso J, Cardoso P, Mota J, Fernandes J, Ferreira J, Boas FV, Pereira P, Macedo G. Artificial intelligence for automatic diagnosis and pleomorphic morphological characterization of malignant biliary strictures using digital cholangioscopy. Sci Rep 2025; 15:5447. [PMID: 39952950 PMCID: PMC11828993 DOI: 10.1038/s41598-025-87279-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Accepted: 01/17/2025] [Indexed: 02/17/2025] Open
Abstract
Diagnosing and characterizing biliary strictures (BS) remains challenging. Artificial intelligence (AI) applied to digital single-operator cholangioscopy (D-SOC) holds promise for improving diagnostic accuracy in indeterminate BS. This multicenter study aimed to validate a convolutional neural network (CNN) model using a large dataset of D-SOC images to automatically detect and characterize malignant BS. D-SOC exams from three centers-Centro Hospitalar Universitário de São João, Porto, Portugal (n = 123), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (n = 18), and New York University Langone Hospital, New York, USA (n = 23)-were included. Frames were categorized based on histopathology. The CNN's performance in detecting tumor vessels, papillary projections, nodules, and masses was assessed. The dataset was split into 90% training and 10% validation sets. Performance metrics included AUC, sensitivity, specificity, PPV, and NPV. Analysis of 96,020 images from 164 D-SOC exams (50,427 malignant strictures and 45,593 benign findings) showed the CNN achieved 92.9% accuracy, 91.7% sensitivity, 94.4% specificity, 95.1% PPV, 93.1% NPV, and an AUROC of 0.95. Accuracy rates for morphological features were 90.8% (papillary projections), 93.6% (nodules), 93.2% (masses), and 78.1% (tumor vessels). AI-driven CNN models hold promise for enhancing diagnostic accuracy in suspected biliary malignancies. This multicenter study contributes diverse datasets to ongoing research, supporting further AI applications in this patient population.
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Affiliation(s)
- Miguel Mascarenhas
- Department of Gastroenterology, Precision Medicine Unit, São João University Hospital, Porto, Portugal.
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal.
- Faculty of Medicine, University of Porto, Porto, Portugal.
- Gastroenterology Department Hospital de São João, Porto, 4200-427, Portugal.
| | - Maria João Almeida
- Department of Gastroenterology, Precision Medicine Unit, São João University Hospital, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
| | - Mariano González-Haba
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro Majadahonda, C/Joaquín Rodrigo, Majadahonda, Madrid, 28220, Spain
| | - Belén Agudo Castillo
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro Majadahonda, C/Joaquín Rodrigo, Majadahonda, Madrid, 28220, Spain
| | - Jessica Widmer
- Department of Gastroenterology, New York University Langone Hospital, New York, USA
| | - António Costa
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro Majadahonda, C/Joaquín Rodrigo, Majadahonda, Madrid, 28220, Spain
| | - Yousef Fazel
- Department of Gastroenterology, New York University Langone Hospital, New York, USA
| | - Tiago Ribeiro
- Department of Gastroenterology, Precision Medicine Unit, São João University Hospital, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Francisco Mendes
- Department of Gastroenterology, Precision Medicine Unit, São João University Hospital, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Miguel Martins
- Department of Gastroenterology, Precision Medicine Unit, São João University Hospital, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Afonso
- Department of Gastroenterology, Precision Medicine Unit, São João University Hospital, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Cardoso
- Department of Gastroenterology, Precision Medicine Unit, São João University Hospital, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joana Mota
- Department of Gastroenterology, Precision Medicine Unit, São João University Hospital, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
| | - Joana Fernandes
- Department of Mechanical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal
| | - João Ferreira
- Department of Mechanical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal
- DigestAID-Digestive Artificial Intelligence Development, Rua Alfredo Allen n.o 455/461, Porto, 4200-135, Portugal
| | - Filipe Vilas Boas
- Department of Gastroenterology, Precision Medicine Unit, São João University Hospital, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Pereira
- Department of Gastroenterology, Precision Medicine Unit, São João University Hospital, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, Precision Medicine Unit, São João University Hospital, Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
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Agudo Castillo B, Mascarenhas M, Martins M, Mendes F, de la Iglesia D, Costa AMMPD, Esteban Fernández-Zarza C, González-Haba Ruiz M. Advancements in biliopancreatic endoscopy - A comprehensive review of artificial intelligence in EUS and ERCP. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116:613-622. [PMID: 38832589 DOI: 10.17235/reed.2024.10456/2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
The development and implementation of artificial intelligence (AI), particularly deep learning (DL) models, has generated significant interest across various fields of gastroenterology. While research in luminal endoscopy has seen rapid translation to clinical practice with approved AI devices, its potential extends far beyond, offering promising benefits for biliopancreatic endoscopy like optical characterization of strictures during cholangioscopy or detection and classification of pancreatic lesions during diagnostic endoscopic ultrasound (EUS). This narrative review provides an up-to-date of the latest literature and available studies in this field. Serving as a comprehensive guide to the current landscape of AI in biliopancreatic endoscopy, emphasizing technological advancements, main applications, ethical considerations, and future directions for research and clinical implementation.
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Affiliation(s)
| | | | - Miguel Martins
- Gastroenterology, Centro Hospitalar Universitário de São João
| | - Francisco Mendes
- Gastroenterology, Centro Hospitalar Universitário de São João, Portugal
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Ang TL. Climate Sustainability as a Catalyst for Quality and Excellence in Gastrointestinal Endoscopy: A Narrative Review. J Dig Dis 2024; 25:638-644. [PMID: 39909063 DOI: 10.1111/1751-2980.13330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2024] [Accepted: 12/31/2024] [Indexed: 02/07/2025]
Abstract
The significant contribution of greenhouse gas (GHG) emissions to global warming and the resultant negative impact on health is well established. Within the hospital setting, the endoscopy center has been ranked third-after the operating theater complex and intensive care unit-in terms of the volume of hazardous medical waste generated. Such regulated medical waste cannot be recycled, and the disposal process results in higher costs and a larger carbon footprint. There have been clarion calls to reduce the number of endoscopic procedures as a means of reducing GHG emissions. Previous studies have demonstrated the carbon footprint of inappropriate endoscopic procedures. However, endoscopy is an important diagnostic and therapeutic tool that has been shown to be cost-effective. A focus simply on reduction in procedural case volume alone raises the unintended consequences of inequitable access to endoscopy for those in need. A more nuanced approach that is aligned with the innate sense of healthcare professional aspirations and pride, in terms of seeking quality and clinical excellence, should be considered. An evidence-based approach, with a focus on quality and efficiency, as well as appropriate and timely use of new technology, will serve as a catalyst for positive behavioral change toward quality procedures and excellence. This will improve patient satisfaction, increase professional expertise and pride, and reduce carbon footprint through minimization of inappropriate and avoidable repeat procedures.
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Affiliation(s)
- Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
- Duke-NUS Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Robles-Medranda C, Baquerizo-Burgos J, Puga-Tejada M, Cunto D, Egas-Izquierdo M, Mendez JC, Arevalo-Mora M, Alcivar Vasquez J, Lukashok H, Tabacelia D. Cholangioscopy-based convoluted neuronal network vs. confocal laser endomicroscopy in identification of neoplastic biliary strictures. Endosc Int Open 2024; 12:E1118-E1126. [PMID: 39398445 PMCID: PMC11466527 DOI: 10.1055/a-2404-5699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 07/24/2024] [Indexed: 10/15/2024] Open
Abstract
Background and study aims Artificial intelligence (AI) models have demonstrated high diagnostic performance identifying neoplasia during digital single-operator cholangioscopy (DSOC). To date, there are no studies directly comparing AI vs. DSOC-guided probe-base confocal laser endomicroscopy (DSOC-pCLE). Thus, we aimed to compare the diagnostic accuracy of a DSOC-based AI model with DSOC-pCLE for identifying neoplasia in patients with indeterminate biliary strictures. Patients and methods This retrospective cohort-based diagnostic accuracy study included patients ≥ 18 years old who underwent DSOC and DSOC-pCLE (June 2014 to May 2022). Four methods were used to diagnose each patient's biliary structure, including DSOC direct visualization, DSOC-pCLE, an offline DSOC-based AI model analysis performed in DSOC recordings, and DSOC/pCLE-guided biopsies. The reference standard for neoplasia was a diagnosis based on further clinical evolution, imaging, or surgical specimen findings during a 12-month follow-up period. Results A total of 90 patients were included in the study. Eighty-six of 90 (95.5%) had neoplastic lesions including cholangiocarcinoma (98.8%) and tubulopapillary adenoma (1.2%). Four cases were inflammatory including two cases with chronic inflammation and two cases of primary sclerosing cholangitis. Compared with DSOC-AI, which obtained an area under the receiver operator curve (AUC) of 0.79, DSOC direct visualization had an AUC of 0.74 ( P = 0.763), DSOC-pCLE had an AUC of 0.72 ( P = 0.634), and DSOC- and pCLE-guided biopsy had an AUC of 0.83 ( P = 0.809). Conclusions The DSOC-AI model demonstrated an offline diagnostic performance similar to that of DSOC-pCLE, DSOC alone, and DSOC/pCLE-guided biopsies. Larger multicenter, prospective, head-to-head trials with a proportional sample among neoplastic and nonneoplastic cases are advisable to confirm the obtained results.
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Affiliation(s)
- Carlos Robles-Medranda
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas – IECED, Guayaquil, Ecuador
| | - Jorge Baquerizo-Burgos
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas – IECED, Guayaquil, Ecuador
| | - Miguel Puga-Tejada
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas – IECED, Guayaquil, Ecuador
| | - Domenica Cunto
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas – IECED, Guayaquil, Ecuador
| | - Maria Egas-Izquierdo
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas – IECED, Guayaquil, Ecuador
| | | | - Martha Arevalo-Mora
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas – IECED, Guayaquil, Ecuador
| | - Juan Alcivar Vasquez
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas – IECED, Guayaquil, Ecuador
| | - Hannah Lukashok
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas – IECED, Guayaquil, Ecuador
| | - Daniela Tabacelia
- Gastroenterology, Elias Emergency University Hospital, Bucuresti, Romania
- Universitatea de Medicină și Farmacie Carol Davila din București, Bucuresti, Romania
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Yang Q, Nie L, Xu J, Li H, Zhu X, Wei M, Yao J. A machine learning-based predictive model for biliary stricture attributable to malignant tumors: a dual-center retrospective study. Front Oncol 2024; 14:1406512. [PMID: 39135994 PMCID: PMC11317252 DOI: 10.3389/fonc.2024.1406512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 07/15/2024] [Indexed: 08/15/2024] Open
Abstract
Background Biliary stricture caused by malignant tumors is known as Malignant Biliary Stricture (MBS). MBS is challenging to differentiate clinically, and accurate diagnosis is crucial for patient prognosis and treatment. This study aims to identify the risk factors for malignancy in all patients diagnosed with biliary stricture by Endoscopic Retrograde Cholangiopancreatography (ERCP), and to develop an effective clinical predictive model to enhance diagnostic outcomes. Methodology Through a retrospective study, data from 398 patients diagnosed with biliary stricture using ERCP between January 2019 and January 2023 at two institutions: the First People's Hospital affiliated with Jiangsu University and the Second People's Hospital affiliated with Soochow University. The study began with a preliminary screening of risk factors using univariate regression. Lasso regression was then applied for feature selection. The dataset was divided into a training set and a validation set in an 8:2 ratio. We analyzed the selected features using seven machine learning algorithms. The best model was selected based on the Area Under the Receiver Operating Characteristic (ROC) Curve (AUROC) and other evaluation indicators. We further evaluated the model's accuracy using calibration curves and confusion matrices. Additionally, we used the SHAP method for interpretability and visualization of the model's predictions. Results RF model is the best model, achieved an AUROC of 0.988. Shap result indicate that age, stricture location, stricture length, carbohydrate antigen 199 (CA199), total bilirubin (TBil), alkaline phosphatase (ALP), (Direct Bilirubin) DBil/TBil, and CA199/C-Reactive Protein (CRP) were risk factors for MBS, and the CRP is a protective factor. Conclusion The model's effectiveness and stability were confirmed, accurately identifying high-risk patients to guide clinical decisions and improve patient prognosis.
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Affiliation(s)
- Qifan Yang
- Department of Gastroenterology, The Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Lu Nie
- Department of Intervention Vascular, Wujin Hospital Affiliated with Jiangsu University, Changzhou, China
| | - Jian Xu
- Department of Gastroenterology, The Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Hua Li
- Department of General Surgery, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
- Key Laboratory of Tumor Molecular Pathology of Baise, Baise, China
| | - Xin Zhu
- Department of Gastroenterology, The Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Mingwei Wei
- Department of General Surgery, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
- Key Laboratory of Tumor Molecular Pathology of Baise, Baise, China
| | - Jun Yao
- Department of Gastroenterology, The Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
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Tang RSY. Endoscopic evaluation of indeterminate biliary strictures: Cholangioscopy, endoscopic ultrasound, or both? Dig Endosc 2024; 36:778-788. [PMID: 38014445 DOI: 10.1111/den.14733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/26/2023] [Indexed: 11/29/2023]
Abstract
Accurate and timely diagnosis of biliary strictures can be challenging. Because the diagnostic sensitivity and accuracy of standard endoscopic retrograde cholangiopancreatography-based tissue sampling for malignancy are suboptimal, additional endoscopic evaluation by cholangioscopy and/or endoscopic ultrasound (EUS) is often necessary to differentiate between malignant and benign biliary strictures to guide clinical management. While direct visualization by cholangioscopy and/or high-resolution imaging by EUS are often the first step in the evaluation of an indeterminate biliary stricture (IDBS), tissue diagnosis by cholangioscopy-guided biopsy and/or EUS-guided fine-needle tissue acquisition is the preferred modality to establish a diagnosis of malignancy. Because each modality has its own strengths and limitations, selection of cholangioscopy and EUS is best guided by the biliary stricture location and local expertise. Artificial intelligence-assisted diagnosis, biopsy forceps with improved design, contrast-enhanced EUS, and dedicated fine-needle biopsy devices are recent technological advances that may further improve the diagnostic performance of cholangioscopy and EUS in patients with IDBS.
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Affiliation(s)
- Raymond S Y Tang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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Lee SH, Song SY. Recent Advancement in Diagnosis of Biliary Tract Cancer through Pathological and Molecular Classifications. Cancers (Basel) 2024; 16:1761. [PMID: 38730713 PMCID: PMC11083053 DOI: 10.3390/cancers16091761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Biliary tract cancers (BTCs), including intrahepatic, perihilar, and distal cholangiocarcinomas, as well as gallbladder cancer, are a diverse group of cancers that exhibit unique molecular characteristics in each of their anatomic and pathological subtypes. The pathological classification of BTCs compromises distinct growth patterns, including mass forming, periductal infiltrating, and intraductal growing types, which can be identified through gross examination. The small-duct and large-duct types of intrahepatic cholangiocarcinoma have been recently introduced into the WHO classification. The presentation of typical clinical symptoms, as well as the extensive utilization of radiological, endoscopic, and molecular diagnostic methods, is thoroughly detailed in the description. To overcome the limitations of traditional tissue acquisition methods, new diagnostic modalities are being explored. The treatment landscape is also rapidly evolving owing to the emergence of distinct subgroups with unique molecular alterations and corresponding targeted therapies. Furthermore, we emphasize the crucial aspects of diagnosing BTC in practical clinical settings.
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Affiliation(s)
- Sang-Hoon Lee
- Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea;
| | - Si Young Song
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03772, Republic of Korea
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Kumar D, Dayal VM, Jha SK, Jha AK, Kumar RK. A Randomized Comparative Study of the Use of Individual Modality and Combination of Endoscopic Retrograde Cholangiopancreatography (ERCP) and Digital Single-Operator Cholangioscopy (DSOC) for Diagnosis of Indeterminate Biliary Strictures. Adv Biomed Res 2024; 13:4. [PMID: 38525391 PMCID: PMC10958731 DOI: 10.4103/abr.abr_220_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND To determine the superiority of the combination of endoscopic retrograde cholangiopancreatography (ERCP) and digital single-operator cholangioscopy (DSOC) in the same sitting over the individual modality alone in patients with indeterminate biliary strictures. MATERIALS AND METHODS A randomized study enrolled 60 adult patients with biliary strictures who were randomized into two groups: ERCP + DSOC and ERCP/DSOC. Histopathologic or cytologic assessment was performed in terms of benign, indeterminate, or malignant nature of the strictures. Procedural adverse events were documented. Accuracy in terms of sensitivity (Sn), specificity (Sp), and predictive value [positive (PPV) and negative (NPV)] were noted. RESULTS As per final diagnosis, in ERCP/DSOC group, there were 12 (40%) benign cases and 18 (60%) malignant cases, and in group ERCP + DSOC, there were 8 (26.67%) benign cases and 22 (73.33%) malignant cases. ERCP/DSOC labeled 16 (53.33%) patients as benign, 8 (26.67%) as malignant, and 6 (20%) as indeterminate, while ERCP + DSOC labeled 8 (26.67%) as benign, 17 (56.67%) as malignant, and 5 (16.67%) as indeterminate. The Sn, Sp, PPV, and NPV of ERCP/DSOC were 44.4%, 75%, 100%, and 56.25%, and for ERCP + DSOC was 77.27%, 62.50%, 100%, and 62.5%, respectively (P = 0.033). Side effects were statistically similar in both the groups (P > 0.05). CONCLUSION To conclude, the combination of ERCP with DSOC is safe and effective with higher diagnostic sensitivity (77.27%) in comparison to standard ERCP or DSOC alone (44.4%) for the diagnosis of biliary strictures.
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Affiliation(s)
- Dheeraj Kumar
- Department of Gastroenterology IGIMS, Patna, Bihar, India
| | | | - Sanjeev K. Jha
- Department of Gastroenterology IGIMS, Patna, Bihar, India
| | - Ashish K. Jha
- Department of Gastroenterology IGIMS, Patna, Bihar, India
| | - Ravi K. Kumar
- Department of Gastroenterology IGIMS, Patna, Bihar, India
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11
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Machuca-Aguado J, Rendón-García R, Álvarez-Muñoz A, Gálvez-Criado JM, Rubio-Garrido FJ, Sánchez-Bernal ML. The value of preoperative histological confirmation in inconclusive biliary strictures: Biliary neurofibroma as a rare cause of icteric obstructive syndrome. GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:803-804. [PMID: 36584753 DOI: 10.1016/j.gastrohep.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/18/2022] [Accepted: 12/02/2022] [Indexed: 12/28/2022]
Affiliation(s)
- Jesús Machuca-Aguado
- Unidad de Gestión Clínica de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, España.
| | - Rosa Rendón-García
- Unidad de Gestión Clínica de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Alejandro Álvarez-Muñoz
- Unidad de Gestión Clínica de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - José Manuel Gálvez-Criado
- Unidad de Gestión Clínica del Aparato Digestivo, Hospital Universitario Virgen Macarena, Sevilla, España
| | | | - María Luisa Sánchez-Bernal
- Unidad de Gestión Clínica de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, España
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12
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Anderloni A. Biliary cannulation in ERCP: you don't need to be a shark if you now can be sharp! Endoscopy 2023; 55:1043-1044. [PMID: 37722408 DOI: 10.1055/a-2164-9565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Affiliation(s)
- Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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13
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Saraiva MM, Ribeiro T, González-Haba M, Agudo Castillo B, Ferreira JPS, Vilas Boas F, Afonso J, Mendes F, Martins M, Cardoso P, Pereira P, Macedo G. Deep Learning for Automatic Diagnosis and Morphologic Characterization of Malignant Biliary Strictures Using Digital Cholangioscopy: A Multicentric Study. Cancers (Basel) 2023; 15:4827. [PMID: 37835521 PMCID: PMC10571941 DOI: 10.3390/cancers15194827] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
Digital single-operator cholangioscopy (D-SOC) has enhanced the ability to diagnose indeterminate biliary strictures (BSs). Pilot studies using artificial intelligence (AI) models in D-SOC demonstrated promising results. Our group aimed to develop a convolutional neural network (CNN) for the identification and morphological characterization of malignant BSs in D-SOC. A total of 84,994 images from 129 D-SOC exams in two centers (Portugal and Spain) were used for developing the CNN. Each image was categorized as either a normal/benign finding or as malignant lesion (the latter dependent on histopathological results). Additionally, the CNN was evaluated for the detection of morphologic features, including tumor vessels and papillary projections. The complete dataset was divided into training and validation datasets. The model was evaluated through its sensitivity, specificity, positive and negative predictive values, accuracy and area under the receiver-operating characteristic and precision-recall curves (AUROC and AUPRC, respectively). The model achieved a 82.9% overall accuracy, 83.5% sensitivity and 82.4% specificity, with an AUROC and AUPRC of 0.92 and 0.93, respectively. The developed CNN successfully distinguished benign findings from malignant BSs. The development and application of AI tools to D-SOC has the potential to significantly augment the diagnostic yield of this exam for identifying malignant strictures.
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Affiliation(s)
- Miguel Mascarenhas Saraiva
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Tiago Ribeiro
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Mariano González-Haba
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro Majadahonda, C/Joaquín Rodrigo, 28220 Majadahonda, Madrid, Spain
| | - Belén Agudo Castillo
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro Majadahonda, C/Joaquín Rodrigo, 28220 Majadahonda, Madrid, Spain
| | - João P. S. Ferreira
- Department of Mechanical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
- DigestAID—Digestive Artificial Intelligence Development, Rua Alfredo Allen n.º 455/461, 4200-135 Porto, Portugal
| | - Filipe Vilas Boas
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - João Afonso
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Francisco Mendes
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Miguel Martins
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Pedro Cardoso
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
| | - Pedro Pereira
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- WGO Gastroenterology and Hepatology Training Center, 4200-319 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
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14
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Yadlapati S, Mulki R, Sánchez-Luna SA, Ahmed AM, Kyanam Kabir Baig KR, Peter S. Clinical approach to indeterminate biliary strictures: Clinical presentation, diagnosis, and workup. World J Gastroenterol 2023; 29:5198-5210. [PMID: 37901449 PMCID: PMC10600956 DOI: 10.3748/wjg.v29.i36.5198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/23/2023] [Accepted: 08/21/2023] [Indexed: 09/20/2023] Open
Abstract
Despite advances in cross-sectional imaging and endoscopic technology, bile duct strictures remain a challenging clinical entity. It is crucial to make an early determination of benign or malignant nature of biliary strictures. Early diagnosis not only helps with further management but also minimizes mortality and morbidity associated with delayed diagnosis. Conventional imaging and endoscopic techniques, particularly endoscopic retrograde cholangiopancreatography (ERCP) and tissue sampling techniques play a key in establishing a diagnosis. Indeterminate biliary strictures (IDBSs) have no definite mass on imaging or absolute histopathological diagnosis and often warrant utilization of multiple diagnostics to ascertain an etiology. In this review, we discuss possible etiologies, clinical presentation, diagnosis, and management of IDBSs. Based on available data and expert opinion, we depict an evidence based diagnostic algorithm for management of IDBSs. Areas of focus include use of traditional tissue sampling techniques such as ERCP with brush cytology, intraductal biopsies, fluorescence in situ hybridization and flow cytometry. We also describe the role of endoscopic ultrasound (EUS)-guided fine needle aspiration and biopsies, cholangioscopy, confocal laser endomicroscopy, and intraductal EUS in management of IDBSs.
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Affiliation(s)
- Sujani Yadlapati
- Department of Gastroenterology and Hepatology, Indiana University Hospital, Indianapolis, IN 46202, USA
| | - Ramzi Mulki
- Department of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Sergio A Sánchez-Luna
- Department of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Ali M Ahmed
- Department of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | | | - Shajan Peter
- Department of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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15
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Mauro A, Mazza S, Scalvini D, Lusetti F, Bardone M, Quaretti P, Cobianchi L, Anderloni A. The Role of Cholangioscopy in Biliary Diseases. Diagnostics (Basel) 2023; 13:2933. [PMID: 37761300 PMCID: PMC10528268 DOI: 10.3390/diagnostics13182933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 09/29/2023] Open
Abstract
Endoscopy plays a central role in diagnostic and therapeutic approaches to biliary disease in both benign and malignant conditions. A cholangioscope is an endoscopic instrument that allows for the direct exploration of the biliary tree. Over the years, technology has improved endoscopic image quality and allowed for the development of an operative procedure that can be performed during cholangioscopy. Different types of instruments are available in this context, and they can be used in different anatomical access points according to the most appropriate clinical indication. The direct visualization of biliary mucosa is essential in the presence of biliary strictures of unknown significance, allowing for the appropriate allocation of patients to surgery or conservative treatments. Cholangioscopy has demonstrated excellent performance in discriminating malignant conditions (such as colangiocarcinoma) from benign inflammatory strictures, and more recent advances (e.g., artificial intelligence and confocal laser endomicroscopy) could further increase its diagnostic accuracy. Cholangioscopy also plays a primary role in the treatment of benign conditions such as difficult bile stones (DBSs). In this case, it may not be possible to achieve complete biliary drainage using standard ERCP. Therapeutic cholangioscopy-guided lithotripsy allows for stone fragmentation and complete biliary drainage. Indeed, other complex clinical situations, such as patients with intra-hepatic lithiasis and patients with an altered anatomy, could benefit from the therapeutic role of cholangioscopy. The aim of the present review is to explore the most recent diagnostic and therapeutic advances in the roles of cholangioscopy in the management of biliary diseases.
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Affiliation(s)
- Aurelio Mauro
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
| | - Stefano Mazza
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
| | - Davide Scalvini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Francesca Lusetti
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Marco Bardone
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
| | - Pietro Quaretti
- Unit of Interventional Radiology, Department of Radiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Lorenzo Cobianchi
- Department of General Surgery, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Andrea Anderloni
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
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16
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Xiong Z, Wang K, Zhang H, Fang Y, Li F, Huang J. Improved fluoroscopy-guided biopsies in the diagnosis of indeterminate biliary strictures: a multi-center retrospective study. Sci Rep 2023; 13:13152. [PMID: 37573370 PMCID: PMC10423265 DOI: 10.1038/s41598-023-39438-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 07/25/2023] [Indexed: 08/14/2023] Open
Abstract
To evaluate the diagnostic accuracy of improved fluoroscopy-guided biopsies for indeterminate biliary strictures (IBDS). A multi-center retrospective study was performed. Patients with IBDS who underwent digital single-operator cholangioscopy (DSOC) and improved fluoroscopy-guided biopsies procedures were included. The individual sensitivity, specificity, and accuracy were analyzed. A total of 67 patients were enrolled in this multi-center retrospective study. The DSOC and improved fluoroscopy-guided biopsies procedures were successfully performed in all cases (100%). The sensitivity, specificity, and accuracy values were 83.3%, 89.5%, and 85.1% for DSOC visual impression; 95.8%, 94.7%, and 95.5% for improved fluoroscopy-guided biopsies procedures, respectively. The sensitivity and accuracy of improved fluoroscopy-guided biopsies were significantly higher compared with DSOC visual impression. Four patients (6.0%, 4/67) occurred adverse events after the procedures. Improved fluoroscopy-guided biopsies had a high diagnostic accuracy of IBDS diagnosis.
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Affiliation(s)
- Zhe Xiong
- Department of Gastroenterology, Changzhou No.2 People's Hospital, Changzhou, China
- Graduate School of Dalian Medical University, Dalian, China
| | - Kuangjing Wang
- Department of Gastroenterology, The People's Hospital of Ma Anshan, Ma Anshan, China
| | - Huahui Zhang
- Department of Gastroenterology, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Ying Fang
- Department of Gastroenterology, Changzhou No.2 People's Hospital, Changzhou, China
- Graduate School of Dalian Medical University, Dalian, China
| | - Fengdong Li
- Department of Gastroenterology, Changzhou No.2 People's Hospital, Changzhou, China
| | - Jin Huang
- Department of Gastroenterology, Changzhou No.2 People's Hospital, Changzhou, China.
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17
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Matsumori T, Uza N, Okada H, Shiokawa M, Maruno T, Kuwada T, Yoshida H, Yasuda M, Yamazaki H, Taura K, Hatano E, Kodama Y, Seno H. Innovative method for the diagnosis of bile duct lesions using a novel tapered-tip sheath system to facilitate biliary biopsies. Gastrointest Endosc 2023; 98:43-50.e1. [PMID: 36775209 DOI: 10.1016/j.gie.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/26/2023] [Accepted: 02/06/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND AND AIMS Pathologic evaluation of bile duct lesions is crucial for a definitive diagnosis and determination of an appropriate therapeutic strategy; however, current methods are limited by several challenges. This study evaluated the impact of a novel tapered-tip sheath system on biliary stricture diagnosis. METHODS This observational study evaluated 47 consecutive patients who underwent transpapillary biliary stricture biopsy using the novel tapered-tip sheath system from July 2020 to March 2022 compared with 51 historical control subjects undergoing conventional biopsies. Technical success rate, total biopsy time, number of biopsy specimens, adequate tissue sampling rate, adverse events, and diagnostic performance for biliary strictures were assessed. RESULTS The technical success rate was favorable in both groups, showing no significant difference (97.9% [46 of 47] vs 88.2% [45 of 51], P = .114). However, the total biopsy time was significantly shorter in the novel system group (3.7 vs 7.7 minutes, P < .001). The number of biopsy specimens did not differ between the groups; however, the novel system group had significantly more cases in which ≥3 tissue samples could be obtained (71.7% [33 of 46] vs 51.1% [23 of 45], P = .043), a higher adequate tissue sampling rate (88.2% vs 66.4%, P < .001), and fewer adverse events (6.4% vs 21.6%, P = .043). Although the diagnostic specificity of both groups was 100%, the novel system group had significantly higher diagnostic sensitivity and accuracy (82.1% vs 50% [P = .004] and 84.8% vs 55.5% [P = .005], respectively). CONCLUSIONS The novel tapered-tip sheath system is a promising tool for biliary stricture diagnosis.
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Affiliation(s)
- Tomoaki Matsumori
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Norimitsu Uza
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Hirokazu Okada
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Shiokawa
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takahisa Maruno
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kuwada
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroyuki Yoshida
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Muneji Yasuda
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hajime Yamazaki
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kojiro Taura
- Department of Gastroenterological Surgery, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Etsuro Hatano
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuzo Kodama
- Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Seno
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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18
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ACG Clinical Guideline: Diagnosis and Management of Biliary Strictures. Am J Gastroenterol 2023; 118:405-426. [PMID: 36863037 DOI: 10.14309/ajg.0000000000002190] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/13/2022] [Indexed: 03/04/2023]
Abstract
A biliary stricture is an abnormal narrowing in the ductal drainage system of the liver that can result in clinically and physiologically relevant obstruction to the flow of bile. The most common and ominous etiology is malignancy, underscoring the importance of a high index of suspicion in the evaluation of this condition. The goals of care in patients with a biliary stricture are confirming or excluding malignancy (diagnosis) and reestablishing flow of bile to the duodenum (drainage); the approach to diagnosis and drainage varies according to anatomic location (extrahepatic vs perihilar). For extrahepatic strictures, endoscopic ultrasound-guided tissue acquisition is highly accurate and has become the diagnostic mainstay. In contrast, the diagnosis of perihilar strictures remains a challenge. Similarly, the drainage of extrahepatic strictures tends to be more straightforward and safer and less controversial than that of perihilar strictures. Recent evidence has provided some clarity in multiple important areas pertaining to biliary strictures, whereas several remaining controversies require additional research. The goal of this guideline is to provide practicing clinicians with the most evidence-based guidance on the approach to patients with extrahepatic and perihilar strictures, focusing on diagnosis and drainage.
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19
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Tonozuka R, Itoi T, Nagai K, Sofuni A, Tsuchiya T, Ishii K, Tanaka R, Mukai S, Minami H, Yamamoto K. A novel peroral digital cholangioscope with a large accessory channel: An experimental study. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2023; 30:401-407. [PMID: 36043228 DOI: 10.1002/jhbp.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/27/2022] [Accepted: 08/07/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND/PURPOSE A peroral cholangioscope (POCS) can allow direct visualization of the biliary mucosa and its use is becoming more widespread due to improvements in functionality, image quality, and operability, as well as the development of related devices. Recently, a novel mother-baby peroral cholangioscope (nMB-POCS) with a large (2-mm) accessory channel has been developed. In this study, we evaluated the feasibility of this novel POCS in a dry simulation and animal model. METHODS We evaluated the ease of insertion and maneuverability of the nMB-POCS, the image quality, and the passage of the devices into the accessory channel and into the common bile duct in a dry and live porcine model. RESULTS In both models, the nMB-POCS could be easily inserted into the duodenoscope and into the distal bile duct and hilum. The image quality was good, and it was possible to observe the surface structure and the vascular network of the bile duct mucosa in detail. CONCLUSIONS The nMB-POCS with its larger accessory channel is expected to improve the efficiency of diagnosis and treatment, and reduce the procedure time. Clinical studies in patients are warranted.
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Affiliation(s)
- Ryosuke Tonozuka
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Kazumasa Nagai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Atsushi Sofuni
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takayoshi Tsuchiya
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Kentaro Ishii
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Reina Tanaka
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Hirohito Minami
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Kenjiro Yamamoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
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20
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Vogel A, Bridgewater J, Edeline J, Kelley RK, Klümpen HJ, Malka D, Primrose JN, Rimassa L, Stenzinger A, Valle JW, Ducreux M. Biliary tract cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2023; 34:127-140. [PMID: 36372281 DOI: 10.1016/j.annonc.2022.10.506] [Citation(s) in RCA: 269] [Impact Index Per Article: 134.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/18/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- A Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School of Hannover, Hannover, Germany
| | - J Bridgewater
- Cancer Institute, University College London (UCL), London, UK
| | - J Edeline
- Department of Medical Oncology, CLCC Eugène Marquis, Rennes, France; Chemistry, Oncogenesis, Stress and Signaling (COSS), INSERM, University of Rennes, Rennes, France
| | - R K Kelley
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, USA
| | - H J Klümpen
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - D Malka
- Department of Medical Oncology, Institut Mutualiste Montsouris, Paris, France; INSERM U1279, Université Paris-Saclay, Villejuif, France
| | - J N Primrose
- University Department of Surgery, University Hospital Southampton, Southampton, UK
| | - L Rimassa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - A Stenzinger
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - J W Valle
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - M Ducreux
- INSERM U1279, Université Paris-Saclay, Villejuif, France; Department of Cancer Medicine, Gustave Roussy, Villejuif, France
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21
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Matsuzawa H, Goto T, Shibuya T, Sato W, Chiba M, Takahashi K, Minami S, Sato Y, Iijima K. A Preoperative Diagnosis of Advanced Cystic Duct Carcinoma Using SpyGlass DS Cholangioscopy: A Report of Two Cases. Intern Med 2022. [PMID: 36261386 DOI: 10.2169/internalmedicine.9732-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Primary cystic duct carcinoma is a rare tumor. The curative treatment of cystic duct carcinoma is complete surgical resection, for which the evaluation of local extension is important. We herein report two cases of cystic duct carcinoma in which a preoperative examination was performed using per-oral cholangioscopy (POCS). Both patients underwent POCS due to suspicion of cystic duct carcinoma based on imaging findings. A visual analysis and biopsy were performed to evaluate local extension, which led to surgery. These cases suggest that POCS is useful for the preoperative assessment of local extension in advanced cystic duct carcinoma.
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Affiliation(s)
- Hisanori Matsuzawa
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
| | - Takashi Goto
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
| | - Tomomi Shibuya
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
| | - Wataru Sato
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
| | - Mitsuru Chiba
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
| | - Kenichi Takahashi
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
| | - Shinichiro Minami
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
| | - Yuki Sato
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
| | - Katsunori Iijima
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Japan
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22
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Abstract
PURPOSE OF REVIEW To summarize the current status and future perspectives of the endoscopic management of biliary strictures. RECENT FINDINGS In addition to conventional diagnostic modalities, such as cross-sectional imaging and endoscopic ultrasonography (EUS), per-oral cholangioscopy is helpful for indeterminate biliary strictures. It allows direct visualization of the biliary tract and targeted biopsy. For distal malignant biliary obstruction (MBO), a self-expandable metal stent (SEMS) via endoscopic retrograde cholangiopancreatography (ERCP) is a standard of care. EUS-guided biliary drainage (EUS-BD) is an emerging alternative to percutaneous transhepatic biliary drainage in cases with failed ERCP. EUS-BD is also an effective salvage option for perihilar MBO, which can not be managed via ERCP or percutaneous transhepatic biliary drainage. Preoperative drainage is necessary for most jaundiced patients as neoadjuvant chemotherapy is widely administered for resectable and borderline resectable pancreatic cancer, and a SEMS is preferred in this setting, too. For benign biliary strictures, a covered SEMS can improve stricture resolution and reduce the number of endoscopic sessions as compared to plastic stents. SUMMARY ERCP and EUS play a central role in the diagnosis and drainage for both malignant and benign biliary strictures.
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23
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Abstract
Bile duct stenosis continues to present a diagnostic dilemma for clinicians. It is important to establish the benign or malignant nature of the stricture early in order to avoid any unnecessary delay in medical treatment or surgery. Tissue acquisition for histological diagnosis is particularly crucial when the initial diagnostic work up is inconclusive. The diagnostic yield from the conventional endoscopic retrograde cholangiopancreatography (ERCP) with brushing and biopsy is suboptimal. Patients with indeterminate biliary strictures (IDBSs) often require a multi-disciplinary diagnostic approach and additional endoscopic evaluation, including cholangioscopy and endoscopic ultrasound, before a final diagnosis can be reached. In this article, we discuss the recent endoscopic advancements in the diagnosis of biliary stricture with a focus on the roles of cholangioscopy and endoscopic ultrasound (EUS).
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24
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Bokemeyer A, Lenze F, Stoica V, Sensoy TS, Kabar I, Schmidt H, Ullerich H. Digital single-operator video cholangioscopy improves endoscopic management in patients with primary sclerosing cholangitis-a retrospective observational study. World J Gastroenterol 2022; 28:2201-2213. [PMID: 35721887 PMCID: PMC9157616 DOI: 10.3748/wjg.v28.i20.2201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/18/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with primary sclerosing cholangitis (PSC) are at a high risk of developing cholestatic liver disease and biliary cancer, and endoscopy is crucial for the complex management of these patients.
AIM To clarify the utility of recently introduced digital single-operator video cholangioscopy (SOVC) for the endoscopic management of PSC patients.
METHODS In this observational study, all patients with a history of PSC and in whom digital SOVC (using the SpyGlass DS System) was performed between 2015 and 2019 were included and retrospectively analysed. Examinations were performed at a tertiary referral centre in Germany. In total, 46 SOVCs performed in 38 patients with a history of PSC were identified. The primary endpoint was the evaluation of dominant biliary strictures using digital SOVC, and the secondary endpoints were the performance of selective guidewire passage across biliary strictures and the diagnosis and treatment of biliary stone disease in PSC patients.
RESULTS The 22 of 38 patients had a dominant biliary stricture (57.9%). In 4 of these 22 patients, a cholangiocellular carcinoma was diagnosed within the stricture (18.2%). Diagnostic evaluation of dominant biliary strictures using optical signs showed a sensitivity of 75% and a specificity of 94.4% to detect malignant strictures, whereas SOVC-guided biopsies to gain tissue for histopathological analysis showed a sensitivity of 50% and a specificity of 100%. In 13% of examinations, SOVC was helpful for guidewire passage across biliary strictures that could not be passed by conventional methods (technical success rate 100%). Biliary stone disease was observed in 17.4% of examinations; of these, in 37.5% of examinations, biliary stones could only be visualized by SOVC and not by standard fluoroscopy. Biliary stone treatment was successful in all cases (100%); 25% required SOVC-assisted electrohydraulic lithotripsy. Complications, such as postinterventional cholangitis and pancreatitis, occurred in 13% of examinations; however, no procedure-associated mortality occurred.
CONCLUSION Digital SOVC is effective and safe for the endoscopic management of PSC patients and may be regularly considered an additive tool for the complex endoscopic management of these patients.
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Affiliation(s)
- Arne Bokemeyer
- Department of Medicine B (Gastroenterology, Hepatology, Endocrinology, Clinical Infectiology), University Hospital Muenster, Muenster 48149, Germany
- Department of Gastroenterology, Hepatology and Transplant Medicine, University Hospital Essen, Essen 45147, Germany
| | - Frank Lenze
- Department of Medicine B (Gastroenterology, Hepatology, Endocrinology, Clinical Infectiology), University Hospital Muenster, Muenster 48149, Germany
| | - Viorelia Stoica
- Department of Medicine B (Gastroenterology, Hepatology, Endocrinology, Clinical Infectiology), University Hospital Muenster, Muenster 48149, Germany
| | - Timur Selcuk Sensoy
- Department of Gastroenterology, Hepatology and Transplant Medicine, University Hospital Essen, Essen 45147, Germany
| | - Iyad Kabar
- Department of Medicine B (Gastroenterology, Hepatology, Endocrinology, Clinical Infectiology), University Hospital Muenster, Muenster 48149, Germany
| | - Hartmut Schmidt
- Department of Gastroenterology, Hepatology and Transplant Medicine, University Hospital Essen, Essen 45147, Germany
| | - Hansjoerg Ullerich
- Department of Medicine B (Gastroenterology, Hepatology, Endocrinology, Clinical Infectiology), University Hospital Muenster, Muenster 48149, Germany
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25
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Dhar Chowdhury S, Jaleel R. Cholangioscopy: Has It Changed Management? JOURNAL OF DIGESTIVE ENDOSCOPY 2022. [DOI: 10.1055/s-0042-1743183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractThe single operator per oral cholangioscope is a catheter-based system that allows for direct visualization of the bile duct and pancreatic duct. The instrument with its improved imaging technique and larger accessory channel allows for high-quality image acquisition and performance of therapeutic and diagnostic procedures within the bile duct and pancreatic duct. There has been an increase in the range of indications for the use of the cholangioscope. The current indications include management of difficult biliary stones, pancreatic calculi, assessment of indeterminate biliary stricture, pancreatic stricture, intra-ductal papillary mucinous neoplasms, and extractions of proximally migrated stents. The use of laser lithotripsy and electro-hydraulic lithotripsy has improved the management of difficult bile duct stones. Direct visualization of biliary and pancreatic duct strictures is helpful in the diagnosis of indeterminate strictures. In this review, we explore how cholangioscopy has changed management.
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Affiliation(s)
| | - Rajeeb Jaleel
- Department of Gastroenterology, Christian Medical College, Vellore, India
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26
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Pereira P, Mascarenhas M, Ribeiro T, Afonso J, Ferreira JPS, Vilas-Boas F, Parente MP, Jorge RN, Macedo G. Automatic detection of tumor vessels in indeterminate biliary strictures in digital single-operator cholangioscopy. Endosc Int Open 2022; 10:E262-E268. [PMID: 35295246 PMCID: PMC8920599 DOI: 10.1055/a-1723-3369] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/05/2021] [Indexed: 12/15/2022] Open
Abstract
Background and study aims Indeterminate biliary strictures pose a significative clinical challenge. Dilated, irregular, and tortuous vessels, often described as tumor vessels, are frequently reported in biliary strictures with high malignancy potential during digital single-operator cholangioscopy (D-SOC). In recent years, the development of artificial intelligence (AI) algorithms for application to endoscopic practice has been intensely studied. We aimed to develop an AI algorithm for automatic detection of tumor vessels (TVs) in D-SOC images. Patients and methods A convolutional neural network (CNN) was developed. A total of 6475 images from 85 patients who underwent D-SOC (Spyglass, Boston Scientific, Marlborough, Massachusetts, United States) were included. Each frame was evaluated for the presence of TVs. The performance of the CNN was measured by calculating the area under the curve (AUC), sensitivity, specificity, positive and negative predictive values. Results The sensitivity, specificity, positive predictive value, and negative predictive value were 99.3 %, 99.4 %, 99.6% and 98.7 %, respectively. The AUC was 1.00. Conclusions Our CNN was able to detect TVs with high accuracy. Development of AI algorithms may enhance the detection of macroscopic characteristics associated with high probability of biliary malignancy, thus optimizing the diagnostic workup of patients with indeterminate biliary strictures.
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Affiliation(s)
- Pedro Pereira
- Department of Gastroenterology, São João University Hospital, Porto, Portugal,WGO Gastroenterology and Hepatology Training Center, Porto, Portugal,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Miguel Mascarenhas
- Department of Gastroenterology, São João University Hospital, Porto, Portugal,WGO Gastroenterology and Hepatology Training Center, Porto, Portugal,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Tiago Ribeiro
- Department of Gastroenterology, São João University Hospital, Porto, Portugal,WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
| | - João Afonso
- Department of Gastroenterology, São João University Hospital, Porto, Portugal,WGO Gastroenterology and Hepatology Training Center, Porto, Portugal
| | - João P. S. Ferreira
- Department of Mechanical Engineering, Faculty of Engineering of the University of Porto, Porto, Portugal,INEGI – Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Filipe Vilas-Boas
- Department of Gastroenterology, São João University Hospital, Porto, Portugal,WGO Gastroenterology and Hepatology Training Center, Porto, Portugal,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Marco P.L. Parente
- Department of Mechanical Engineering, Faculty of Engineering of the University of Porto, Porto, Portugal,INEGI – Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Renato N. Jorge
- Department of Mechanical Engineering, Faculty of Engineering of the University of Porto, Porto, Portugal,INEGI – Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, São João University Hospital, Porto, Portugal,WGO Gastroenterology and Hepatology Training Center, Porto, Portugal,Faculty of Medicine of the University of Porto, Porto, Portugal
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27
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Hanks M, Ryder S, Zaitoun A. The Role Of Cytology In The Investigation And Management Of Pancreatobiliary Lesions With A Transition Towards A Standardised Reporting System: An Institutional Perspective. Cytopathology 2022; 33:293-300. [PMID: 35231151 DOI: 10.1111/cyt.13115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/28/2022]
Abstract
Pancreatobiliary pathology encompasses all benign and malignant disease within the pancreas and biliary tract; pancreatic cancer is currently the seventh leading cause of death worldwide accounting for approximately 466,000 deaths per annum. Cytology has been increasingly used in the physician's toolbox to provide an accurate, non-invasive and cost-effective modality for the diagnosis of pancreatobiliary lesions. The cytological appearance alone may be insufficient to establish the diagnosis and it is crucial for effective clinicopathological correlation in a multidisciplinary setting highlighting, the vital role of the pathologist to ensure effective and quality care. The advent of modern diagnostic techniques has allowed for a less invasive approach to tissue sampling which when combined with routine staining and specialised immunohistochemistry can help guide the diagnosis. The Papanicolaou Classification is comparable to the current C1-C5 system which will enable standardised reporting to help to improve communication with clinical colleagues and subsequent patient management and our article will discuss the criteria used by cytopathologists to determine the grade of both pancreatic and biliary lesions.
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Affiliation(s)
- Matthew Hanks
- Department of Cellular Pathology, Nottingham University Hospitals, Nottingham, UK, NG7 2UH
| | - Stephen Ryder
- Clinical Research and Innovation, Nottingham University Hospitals, Nottingham, UK, NG7 2UH
| | - Abed Zaitoun
- Department of Cellular Pathology, Nottingham University Hospitals, Nottingham, UK, NG7 2UH
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28
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Subhash A, Buxbaum JL, Tabibian JH. Peroral cholangioscopy: Update on the state-of-the-art. World J Gastrointest Endosc 2022; 14:63-76. [PMID: 35316979 PMCID: PMC8908329 DOI: 10.4253/wjge.v14.i2.63] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/25/2021] [Accepted: 01/17/2022] [Indexed: 02/06/2023] Open
Abstract
Peroral cholangioscopy (POC) is an endoscopic procedure that allows direct intraductal visualization of the biliary tract. POC has emerged as a vital tool for indeterminate biliary stricture evaluation and treatment of difficult biliary stones. Over several generations of devices, POC has fulfilled additional clinical needs where other diagnostic or therapeutic modalities have been inadequate. With adverse event rates comparable to standard endoscopic retrograde cholangioscopy and unique technical attributes, the role of POC is likely to continue expand. In this frontiers article, we highlight the existing and growing clinical applications of POC as well as areas of ongoing research.
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Affiliation(s)
- Amith Subhash
- Department of Gastroenterology, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV 89102, United States
| | - James L Buxbaum
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine of USC, Los Angeles, NV 90033, United States
| | - James H Tabibian
- David Geffen School of Medicine at UCLA, Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA 91342, United States
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, NV 90095, United States
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29
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Rațiu I, Lupușoru R, Lungeanu D, Popescu A, Sporea I, Goldiș A, Dănilă M, Miuțescu B, Moga T, Barbulescu A, Tăban S, Dema A, Șirli R. Diagnosis of malignant biliary obstruction: pondering over the ERCP, MRCP and histology. J Int Med Res 2022; 50:3000605221076924. [PMID: 35170356 PMCID: PMC8855398 DOI: 10.1177/03000605221076924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/10/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To compare the diagnostic accuracy of endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance pancreatography (MRCP) and histological examination for malignant biliary obstruction. METHODS This retrospective study included patients admitted for biliary obstruction caused by biliary tree malignancy that underwent ERCP, MRCP and histological examination. Data were collected from the medical records. The primary endpoints were the area under the receiver operating characteristic (AUROC) curve value, sensitivity, specificity and overall diagnostic accuracy of the three procedures in terms of a final diagnosis of obstructive biliary malignancy; and the agreement between ERCP, MRCP and histological examination with the final diagnosis. RESULTS A total of 160 patients were included in the study (85 males, 53.1%; mean ± SD age, 69.31 ± 10.96 years). Considering the final diagnosis, the performance of MRCP, ERCP and histology in assessing biliary tumours produced AUROC values of 0.88 (95% confidence interval [CI] 0.75, 0.90), 0.94 (95% CI 0.85, 0.99) and 0.80 (95% CI 0.70, 0.82), respectively. ERCP presented higher sensitivity, overall diagnostic accuracy and agreement with the final diagnosis than MRCP and histological examination. CONCLUSION These current data suggest that invasive methods such as ERCP with biopsy remain more reliable than non-invasive methods.
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Affiliation(s)
- Iulia Rațiu
- Advanced Regional Research Centre in Gastroenterology and
Hepatology, Department of Internal Medicine II, Discipline of Gastroenterology
and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara,
Romania
| | - Raluca Lupușoru
- Advanced Regional Research Centre in Gastroenterology and
Hepatology, Department of Internal Medicine II, Discipline of Gastroenterology
and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara,
Romania
- Centre for Modelling Biological Systems and Data Analysis,
Department of Functional Sciences, “Victor Babes” University of Medicine and
Pharmacy Timisoara, Romania
| | - Diana Lungeanu
- Centre for Modelling Biological Systems and Data Analysis,
Department of Functional Sciences, “Victor Babes” University of Medicine and
Pharmacy Timisoara, Romania
| | - Alina Popescu
- Advanced Regional Research Centre in Gastroenterology and
Hepatology, Department of Internal Medicine II, Discipline of Gastroenterology
and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara,
Romania
| | - Ioan Sporea
- Advanced Regional Research Centre in Gastroenterology and
Hepatology, Department of Internal Medicine II, Discipline of Gastroenterology
and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara,
Romania
| | - Adrian Goldiș
- Advanced Regional Research Centre in Gastroenterology and
Hepatology, Department of Internal Medicine II, Discipline of Gastroenterology
and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara,
Romania
| | - Mirela Dănilă
- Advanced Regional Research Centre in Gastroenterology and
Hepatology, Department of Internal Medicine II, Discipline of Gastroenterology
and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara,
Romania
| | - Bogdan Miuțescu
- Advanced Regional Research Centre in Gastroenterology and
Hepatology, Department of Internal Medicine II, Discipline of Gastroenterology
and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara,
Romania
| | - Tudor Moga
- Advanced Regional Research Centre in Gastroenterology and
Hepatology, Department of Internal Medicine II, Discipline of Gastroenterology
and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara,
Romania
| | - Andreea Barbulescu
- Advanced Regional Research Centre in Gastroenterology and
Hepatology, Department of Internal Medicine II, Discipline of Gastroenterology
and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara,
Romania
| | - Sorina Tăban
- ANAPATMOL Research Centre, Discipline of Morphopathology,
Department of Microscopic Morphology, “Victor Babes” University of Medicine and
Pharmacy Timisoara, Romania
| | - Alis Dema
- ANAPATMOL Research Centre, Discipline of Morphopathology,
Department of Microscopic Morphology, “Victor Babes” University of Medicine and
Pharmacy Timisoara, Romania
| | - Roxana Șirli
- Advanced Regional Research Centre in Gastroenterology and
Hepatology, Department of Internal Medicine II, Discipline of Gastroenterology
and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara,
Romania
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30
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Lee T, Teng TZJ, Shelat VG. Choledochoscopy: An update. World J Gastrointest Endosc 2021; 13:571-592. [PMID: 35070020 PMCID: PMC8716986 DOI: 10.4253/wjge.v13.i12.571] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/23/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
Choledochoscopy, or cholangioscopy, is an endoscopic procedure for direct visualization within the biliary tract for diagnostic or therapeutic purposes. Since its conception in 1879, many variations and improvements are made to ensure relevance in diagnosing and managing a range of intrahepatic and extrahepatic biliary pathologies. This ranges from improved visual impression and optical guided biopsies of indeterminate biliary strictures and clinically indistinguishable pathologies to therapeutic uses in stone fragmentation and other ablative therapies. Furthermore, with the evolving understanding of biliary disorders, there are significant innovative ideas and techniques to fill this void, such as nuanced instances of biliary stenting and retrieving migrated ductal stents. With this in mind, we present a review of the current advancements in choledo-choscopy with new supporting evidence that further delineates the role of choledochoscopy in various diagnostic and therapeutic interventions, complications, limitations and put forth areas for further study.
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Affiliation(s)
- Tsinrong Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Thomas Zheng Jie Teng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Vishal G Shelat
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
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31
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Del Vecchio Blanco G, Mossa M, Troncone E, Argirò R, Anderloni A, Repici A, Paoluzi OA, Monteleone G. Tips and tricks for the diagnosis and management of biliary stenosis-state of the art review. World J Gastrointest Endosc 2021; 13:473-490. [PMID: 34733408 PMCID: PMC8546565 DOI: 10.4253/wjge.v13.i10.473] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/24/2021] [Accepted: 08/17/2021] [Indexed: 02/06/2023] Open
Abstract
Biliary stenosis may represent a diagnostic and therapeutic challenge resulting in a delay in diagnosis and initiation of therapy due to the frequent difficulty in distinguishing a benign from a malignant stricture. In such cases, the diagnostic flowchart includes the sequential execution of imaging techniques, such as magnetic resonance, magnetic resonance cholangiopancreatography, and endoscopic ultrasound, while endoscopic retrograde cholangiopancreatography is performed to collect tissue for histopathological/cytological diagnosis or to treat the stenosis by insertion of stent. The execution of percutaneous transhepatic drainage with subsequent biopsy has been shown to increase the possibility of tissue diagnosis after failure of the above techniques. Although the diagnostic yield of histopathology and imaging has increased with improvements in endoscopic ultrasound and peroral cholangioscopy, differential diagnosis between malignant and benign stenosis may not be easy in some patients, and strictures are classified as indeterminate. In these cases, a multidisciplinary workup including biochemical marker assays and advanced technologies available may speed up a diagnosis of malignancy or avoid unnecessary surgery in the event of a benign stricture. Here, we review recent advancements in the diagnosis and management of biliary strictures and describe tips and tricks to increase diagnostic yields in clinical routine.
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Affiliation(s)
| | - Michelangela Mossa
- Department of Systems Medicine, Gastroenterology Unit, University of Rome Tor Vergata, Rome 00133, Italy
| | - Edoardo Troncone
- Department of Systems Medicine, Gastroenterology Unit, University of Rome Tor Vergata, Rome 00133, Italy
| | - Renato Argirò
- Department of Interventional Radiology, University of Rome Tor Vergata, Rome 00133, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital & Humanitas University, Rozzano 20093, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital & Humanitas University, Rozzano 20093, Italy
| | - Omero Alessandro Paoluzi
- Department of Systems Medicine, Gastroenterology Unit, University of Rome Tor Vergata, Rome 00133, Italy
| | - Giovanni Monteleone
- Department of Systems Medicine, Gastroenterology Unit, University of Rome Tor Vergata, Rome 00133, Italy
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32
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Clinical Outcomes of Digital Cholangioscopy-Guided Procedures for the Diagnosis of Biliary Strictures and Treatment of Difficult Bile Duct Stones: A Single-Center Large Cohort Study. J Clin Med 2021; 10:jcm10081638. [PMID: 33921514 PMCID: PMC8069886 DOI: 10.3390/jcm10081638] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 12/12/2022] Open
Abstract
Although Spy DS (SpyGlass DS Direct Visualization System) is considered to be useful for the diagnosis of bile duct strictures and the treatment of bile duct stones, there is limited data to date validating its efficacy. We hence retrospectively evaluated the clinical outcomes of the use of Spy DS in a large number of patients. A total of 183 patients who underwent Spy DS-guided procedures for indeterminate bile duct strictures (n = 93) and bile duct stones (n = 90) were analyzed retrospectively. All patients (93/93) with bile duct strictures successfully underwent visual observation, and 95.7% (89/93) of these patients successfully underwent direct biopsy. The sensitivity, specificity, and overall accuracy were 94.7%, 83.3%, and 90.3%, respectively, for visual impression; 80.9%, 100%, and 89.2%, respectively, for histopathological analysis of a direct biopsy; and 96.5%, 91.7%, and 94.6%, respectively, for visual impression combined with biopsy. Successful visualization of the stones was achieved in 98.9% (89/90) of the patients, and complete stone removal was achieved in 92.2% (83/90) of the patients, with an average of 3.3 procedures. The adverse events rate was 17.5% (32/183; cholangitis in 15 patients, fever the following day in 25, pancreatitis in 1, hemorrhage in 1, and gastrointestinal perforation in 1). No administration of antibiotics before the procedure was found to be a statistically significant risk factor for the development of fever after the procedure (p < 0.01). Spy DS-guided procedures are effective for the diagnosis and treatment of bile duct lesions and can be performed with a low risk of serious adverse events.
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