Minireviews
Copyright ©The Author(s) 2015.
World J Gastrointest Endosc. Dec 10, 2015; 7(18): 1268-1278
Published online Dec 10, 2015. doi: 10.4253/wjge.v7.i18.1268
Table 2 Comparison of advanced endoscopic imaging modalities
AdvantagesDisadvantages
ERCPWidely availableProcedural risks
Workhorse technique with numerous accessoriesFluoroscopic (and endoscopic) images only
Facilitates other diagnostic modalities (e.g., biliary brushing, biopsy, endomicroscopy) as well as therapyLow sensitivity of conventional cytology and intraductal biopsies
EUSProvides staging informationLimited views of the intrahepatic biliary tree (and non-visualization of the right intrahepatic ductal system)
Permits FNAGenerally nondiagnostic in and of itself without FNA
Can facilitate difficult biliary cannulationRisk of tumor seeding if FNA primary tumor
IDUSCan help direct ERCP-guided tissue acquisitionLimited depth of imaging
Infrequently used in routine practice
CholangioscopyExcellent visualization of the biliary mucosa (with digital cholangioscopes)High cost (disposable system $2000 per case)
May improve sensitivity, specificity, and overall accuracy compared to ERCP aloneLikely higher rates of pancreatitis, cholangitis, and perforation compared to ERCP alone
Time-consuming
Not widely available
CLEExcellent sensitivity and negative predictive valueMarginal interobserver agreement
Provides imaging at a cellular and sub-cellular level (lateral resolution of 3.5 μm)Contact imaging of a very limited regional surface
Time-consuming
Not widely available
OCTHigh resolutionSuboptimal sensitivity
Improved sensitivity compared to ERCP-guided tissue acquisitionResolution not as high as CLE
Highly specificNot widely available
Permits larger surfaces areas to be examined compared to CLENot well-validated