Per oral cholangiopancreatoscopy in pancreatico biliary diseases - Expert consensus statements

Table 3 Consensus statement 2

In patients with indeterminate biliary strictures, POCS and POCS-guided targeted biopsy is useful for establishing a definitive diagnosis

Recommendation Grade B

Quality of evidence: 2++

Technical success: Technical success for POCS with or without POCS-guided biopsy is reported to be 66% to 95% when defined as ability to reach the targeted lesion and, if desired, obtain a biopsy adequate for histopathology

Diagnostic accuracy: Diagnostic measures of POCS with or without POCS-guided biopsy for malignancy were explicitly reported for a total of 980 cases in 11 studies. Reported sensitivity ranged from 49% to 100% and specificity ranged from 77% to 100%. In three prospective trials reporting separately on POCS alone and on POCS-guided biopsy and representing 297 patients, the weighted average sensitivity and specificity were 83% and 96% for POCS alone and were lower at 56% and 81% for POCS-guided biopsy

Intrinsic vs extrinsic strictures: POCS-guided biopsy is significantly higher for intrinsic than extrinsic tumors, and may be particularly useful in PSC patients prior to liver transplantation

POCS findings in indeterminate strictures: Findings of POCS such as tortuous and irregularly dilated vessels, intraductal nodules or masses, infiltrative or ulcerated strictures, and papillary or villous mucosal projections are reported to be associated with malignancy. Generally POCS is reported to improve yield of associated ERCP-guided biopsy. POCS with NBI was reported to significantly improve diagnostic accuracy over white light POCS

Altered patient management: Changed patient management following POCS is reported in as many as 2/3 of patients when measured. Impact of POCS on pre-operative diagnosis may impact a surgical decision. POCS combined with IDUS was reported useful in guiding patient management in portal biliopathy. POCS was also reported useful for assessment of anastomotic strictures after liver transplantation

Complications: Reported overall complication rates range from 6.6% to 9%. The most common complication is cholangitis, reported in approximately 5% of cases. There is one report of fatal cholangitis

POCS: Peroral cholangioscopy; PSC: Primary sclerosing cholangitis; ERCP: Endoscopic retrograde cholangiopancreatography; NBI: Narrow band imaging; IDUS: Intraductal ultrasonography.