Dataset Information

Management of malignant biliary diseases by the use of peroral and percutaneous cholangioscopy.

ABSTRACT:

Background and aims

The single-operator digital cholangioscope has allowed visual access to the biliary tree and the ability to perform selective biopsies. This has significantly improved our diagnostic yield in bile-duct disorders. Cholangioscopy requires specialized equipment and expertise. It is especially challenging in altered anatomy for various reasons, including difficulty in accessing the biliary tree, difficulty in maintaining endoscope position, and difficulty in using ERCP specialized tools. In addition, the use of cholangioscopy in interventional procedures has been very limited. In this video, we demonstrate some of the diagnostic and therapeutic uses of percutaneous cholangioscopy in patients with altered anatomy of the biliary tree.

Methods

Percutaneous cholangioscopy was performed in 3 different procedures in 2 patients with altered anatomy of the biliary tree. The first was for the diagnosis of a distally located malignant biliary stricture, the second was for management of hemobilia, and the third was for biliary stent placement.

Results

Technical and clinical success was achieved in all 3 situations. There were no procedure-related adverse events.

Conclusion

The use of percutaneous cholangioscopy in altered anatomy for diagnostic and therapeutic uses is safe and effective and may prove very useful in selected unusual conditions.

SUBMITTER: Alshati A

PROVIDER: S-EPMC6730491 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundPeroral cholangioscopy (POCS)-guided forceps biopsy is a method for diagnosing indeterminate biliary strictures and for the preoperative identification of the exact perihilar and distal margins of biliary tract cancer (BTC). However, POCS-guided forceps biopsy may result in an insufficient amount of specimen at times. Therefore, we evaluated the adequate tissue acquisition rate and the factors affecting the adequate tissue acquisition of POCS-guided forceps biopsy for the biliary tract.MethodsPatients who underwent POCS-guided forceps biopsy for biliary disease between September 2016 and October 2018 at our hospital were enrolled retrospectively. We evaluated the adequate tissue acquisition rate of POCS-guided forceps biopsy for the biliary lesion and that for non-stenotic bile duct. In addition, the factors affecting the adequate tissue acquisition rate of POCS-guided forceps biopsy were evaluated.ResultsWe enrolled 47 patients with biliary disease and performed POCS-guided forceps biopsy for biliary lesion and POCS-guided forceps mapping biopsy for non-stenotic bile duct in 40 and 36 patients, respectively. The adequate tissue acquisition rates of POCS-guided forceps biopsy for biliary lesions and that for non-stenotic bile duct were 86.4%, and 68.9%, respectively. In the multivariate logistic regression analyses, age, and previous biliary stenting before POCS were factors affecting the adequate tissue acquisition rate of POCS-guided forceps biopsy for the biliary lesion. For non-stenotic bile duct, the location of the biliary lesion, endoscopic sphincterotomy (EST), and procedure time of POCS were factors affecting the adequate tissue acquisition rate of POCS-guided forceps mapping biopsy.ConclusionsPrevious biliary stenting was a factor affecting a low tissue acquisition rate of POCS-guided forceps biopsy for the biliary lesion. In the POCS-guided forceps mapping biopsy, the location of the biliary lesion, EST, and procedure time were factors affecting tissue acquisition rates.