Brief Article
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World J Gastrointest Endosc. Jan 16, 2014; 6(1): 20-26
Published online Jan 16, 2014. doi: 10.4253/wjge.v6.i1.20
A new peroral mother-baby endoscope system for biliary tract disorders
Christian Prinz, Andreas Weber, Stefanie Goecke, Bruno Neu, Alexander Meining, Eckart Frimberger
Christian Prinz, Stefanie Goecke, Medical Department, University of Witten, Lehrstuhl für Innere Medizin 2, Helios Klinikum Wuppertal, 42283 Wuppertal, Germany
Andreas Weber, Bruno Neu, Alexander Meining, Eckart Frimberger, Medical Department, Technische Universität München, 81675 München, Germany
Author contributions: Prinz C and Frimberger E designed the research; Goecke S, Neu B and Weber A performed the data acquisition; Prinz C and Frimberger E wrote the manuscript; Neu B, Meining A, Prinz C, Weber A and Frimberger E performed the endoscopic procedures; and Prinz C is the corresponding author.
Correspondence to: Christian Prinz, Professor, Medical Department, University of Witten, Lehrstuhl für Innere Medizin 2, Helios Klinikum Wuppertal, Helios Klinikum Wuppertal Heusnerstr. 40, 42283 Wuppertal, Germany. christian.prinz@helios-kliniken.de
Telephone: +49-202-8962243 Fax: +49-202-8962244
Received: September 9, 2013
Revised: December 4, 2013
Accepted: January 6, 2014
Published online: January 16, 2014
Abstract

AIM: To investigate a new mother-baby system, consisting of a peroral cholangioscope and a duodenoscope in patients regarding its feasibility.

METHODS: In the study period from January 2007 to February 2010, 76 consecutive patients (33 men, 43 women; mean age 63 years old) were included in this pilot series. Endoluminal images and biopsies were obtained from 55 patients with indeterminate strictures, while 21 patients had fixed filling defects. The diagnostic accuracy of peroral cholangioscopy (POCS) in the visualization of strictures and tissue sampling was evaluated, and therapeutic success was monitored. Follow-up was performed over at least 9 mo.

RESULTS: A total of 55 patients had indeterminate strictures. Using the criteria “circular stenosis” and “irregular surface or margins”, POCS correctly described 27 out of 28 malignant biliary strictures and 25 out of 27 benign lesions (sensitivity, 96.4%; specificity, 92.6%, diagnostic accuracy 94.5%). Visually targeted forceps biopsies were performed in 55 patients. Tissue sampling during POCS revealed malignancy in 18 of 28 cases (sensitivity: 64.3%). In 21 patients with fixed filling defects, 10 patients with bile duct stones were successfully treated with conventional stone removal. Nine patients with difficult stones (5 giant stones and 4 intrahepatic stones) were treated with visually guided laser lithotripsy. Two patients in the group with unclear fixed filling defects had bile duct adenoma or papillary tumors and were surgically treated.

CONCLUSION: The new 95 cm POCS allows for accurate discrimination of strictures and fixed filling defects in the biliary tree, provides improved sensitivity of endoscopically guided biopsies and permits therapeutic approaches for difficult intrahepatic stones.

Keywords: Bile duct stenosis, Stones, Mother baby endoscopy, Peroral cholangioscopy, Cholangioscopy, Endoscopic retrograde cholangiopancreatography

Core tip: A new mother-baby system, consisting of a peroral baby cholangioscope and a maternal duodenoscope, was investigated in patients regarding its feasibility. Using the criteria “circular stenosis” and “irregular surface or margins”, peroral cholangioscopy (POCS) correctly described 27 out of 28 malignant biliary strictures and 25 out of 27 benign lesions (sensitivity, 96.4%; specificity, 92.6%, diagnostic accuracy 94.5%). The new 95 cm POCS allows for accurate discrimination of strictures and fixed filling defects in the biliary tract, provides improved sensitivity of endoscopically guided biopsies and permits therapeutic approaches for difficult intrahepatic stones.