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Diagnostic accuracy and interobserver agreement of cholangioscopy for indeterminate biliary strictures: A single-center experience.

Author information

Affiliations

  • 1. Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Lombardia, Italy.
      Authors
    • Milluzzo SM 1
    (1 author)
  • 2. Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Roma, Lazio, Italy; Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Centre for Endoscopic Research Therapeutics and Training (CERTT), Roma, Lazio, Italy.
      Authors
    • Landi R 2
    • Perri V 2
    • Familiari P 2
    • Boškoski I 2
    • Spada C 2
    • Costamagna G 2
    • Tringali A 2
    (7 authors)
  • 3. Facility of Epidemiology and Biostatistics, Gemelli Generator, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
      Authors
    • Pafundi PC 3
    (1 author)
  • 4. Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Roma, Lazio, Italy.
      Authors
    • Farina A 4
    (1 author)
  • 5. Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC di Anatomia Patologica, Roma, Lazio, Italy; Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Department of Pathology, Roma, Lazio, Italy.
      Authors
    • Ricci R 5
    (1 author)

ORCIDs linked to this article

Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 27 Nov 2023, 56(5):847-852
https://doi.org/10.1016/j.dld.2023.11.017 PMID: 38016895 

Abstract 

Background and study aims

Characterization of indeterminate biliary strictures (IDBS) still represents a major challenge. Digital single-operator cholangioscopy (DSOC) could potentially overcome limits of conventional biopsy and brush sampling. The aim of this study was to compare diagnostic accuracy of visual evaluation and DSOC-guided biopsies to conventional trans-papillary sampling techniques and to evaluate the inter-observer agreement (IOA) on visual diagnosis.

Patients and methods

All consecutive patients undergoing DSOC-guided biopsy after conventional sampling techniques for IDBS during a six-year period were retrospectively evaluated. Final diagnosis was based on histological evaluation of the surgical specimen if available or a clinical follow-up of at least 6 months. For IOA, 20-second DSOC clips were retrospectively reviewed by 6 experts and 6 trainees and classified according to the Monaco Classification.

Results

Thirty-five patients underwent DSOC for IDBS in the study period; 14 patients (F = 9) with a median age of 64 years (range 53-76) met the study aim. After DSOC, strictures location was changed in three patients (additional yield of 21.4 %). Intraductal DSOC-guided biopsy were technically successful in all cases, with an adequacy of 92.8 %. No adverse events were recorded. Final diagnosis was benign disease in five cases and cholangiocarcinoma in the others. For IOA, 29 videos were evaluated with almost perfect agreement for final diagnosis (kappa 0.871; agreement 93.1, p <0.001), although overall accuracy of DSOC visual finding was 73.6 % and 64.4 % for experts and trainees, respectively.

Conclusions

DSOC could improve diagnostic accuracy for IDBS, since it showed high sensitivity for visual finding and high specificity for DSOC guided-biopsy. Visual diagnosis seems reliable for diagnosis using the Monaco Classification.

Full text links 

Read article at publisher's site: https://doi.org/10.1016/j.dld.2023.11.017

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