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©The Author(s) 2022.
World J Gastroenterol. May 28, 2022; 28(20): 2201-2213
Published online May 28, 2022. doi: 10.3748/wjg.v28.i20.2201
Published online May 28, 2022. doi: 10.3748/wjg.v28.i20.2201
Table 1 Characteristics of patients with primary sclerosing cholangitis undergoing digital single-operator video cholangioscopy
Variable | Patients (n = 38) |
Primary sclerosing cholangitis, n (%) | 38 (100) |
Age (in years) | 44.8 (± 2.1) |
Male, n (%) | 26 (68.4) |
Female, n (%) | 12 (31.6) |
Liver cirrhosis, n (%) | 20 (52.6) |
Enlisted for liver transplantation, n (%) | 11 (28.9) |
Diagnosis of a cholangiocellular carcinoma, n (%) | 4 (10.5) |
Table 2 Basic analysis of digital single-operator video cholangioscopies performed in patients with primary sclerosing cholangitis
Variable | Digital SOVC (n = 46) |
Type of digital SOVC | |
Initial examinations, n (%) | 38 (82.6) |
Repeated examinations, n (%) | 8 (17.4) |
Main indication for using SOVC | |
Stricture assessment, n (%) | 37 (80.4) |
Selective guidewire placement, n (%) | 6 (13) |
Cholangiolithiasis, n (%) | 2 (4.3) |
Others, n (%) | 1 (2.2) |
Clinical patient data before SOVC (multiple items permitted) | |
Prior papillotomy, n (%) | 41 (89.1) |
Elevated serum bilirubin level (> 1.2 mg/dl), n (%) | 30 (65.2) |
Prior post-ERC-pancreatitis, n (%) | 10 (21.7) |
Type of digital SOVC | |
ERC-based digital SOVC, n (%) | 46 (100) |
Total examination time (ERC + digital SOVC; min) | 73 (± 5.2); n = 40/46 |
Dysfunction of the SOVC-system, n (%) | 1 (2.2) |
Procedures during SOVC-examination (multiple items permitted) | |
SOVC-assisted guidewire insertion, n (%) | 39 (84.7) |
SOVC-assisted forceps biopsies, n (%) | 25 (54.3) |
SOVC-assisted EHL, n (%) | 2 (4.3) |
Additive procedures during ERC-examination (multiple items permitted) | |
Balloon dilation of the biliary tract, n (%) | 35 (76.1) |
New papillotomy, n (%) | 7 (15.2) |
Conventional transpapillary biopsy, n (%) | 6 (13.0) |
Endoprosthesis placement, n (%) | 5 (10.9) |
Periinterventional application of drugs to prevent AE | |
Antibiotics, n (%) | 46 (100) |
NSAID (Diclofenac/Indomethacin), n (%) | 6 (13) |
Table 3 Evaluation of dominant biliary strictures in patients with primary sclerosing cholangitis using digital single-operator video cholangioscopy (n = 22)
Variable | Dominant strictures (n = 22) |
Entity of dominant stricture, n (%) | |
Benign | 18 (81.8) |
Malignant | 4 (18.2) |
Localization of dominant stricture, n (%) | |
Intrahepatic | 13 (59.1) |
Extrahepatic | 3 (13.6) |
Intra- and extrahepatic crossing | 6 (27.3) |
Visual evaluation of stricture by endoscopists, n (%) | |
Suspicious for malignancy | 4 (18.2) |
Suspicious for benignancy | 18 (81.8) |
SOVC-guided forceps biopsies, n (%) | |
Carcinoma/high-grade dysplasia | 2 (9.1) |
Benign findings | 10 (45.5) |
Inadequate material | 1 (4.5) |
Table 4 Diagnostic efficacy of digital single-operator video cholangioscopy for diagnosing malignancy in dominant biliary strictures in patients with primary sclerosing cholangitis (n = 22; cholangioscopic-assisted visual evaluation, n = 22 and cholangioscopic-guided biopsies, n = 12)
Variable | Accuracy (%) | Sensitivity (%) | Specificity (%) | Pos. pred. value (%) | Neg. pred. value (%) |
Visual evaluation (95%CI) | 90.9 (72.8-99.2) | 75 (25.2-97.8) | 94.4 (83.4-99.5) | 75 (25.2-97.8) | 94.4 (83.4-99.5) |
Histological evaluation (95%CI) | 83.3 (57.2-83.3) | 50 (10.8-50.0) | 100 (80.4-100) | 100 (21.7-100) | 80 (64.3-80) |
Table 5 Diagnosis and treatment of biliary stone disease and performance of selective guidewire placements across biliary strictures (with a previous failure of conventional endoscopic methods to pass a guidewire) using digital single-operator video cholangioscopy in patients with primary sclerosing cholangitis
Variable | Examinations (n = 46) |
Cholangiolithiasis, n (%) | 8/46 (17.3) |
Localization | |
Extrahepatic, n (%) | 3/8 (37.5) |
Intrahepatic, n (%) | 3/8 (37.5) |
Intra- and extrahepatic, n (%) | 2/8 (25) |
Stone size (range) | 3-20 mm |
Stone number (range) | 1-5 |
Treatment | |
Complete success (conventional ± EHL), n (%) | 8/8 (100) |
Success only via use of EHL, n (%) | 2/8 (25) |
Stone identification only via SOVC, n (%) | 3/8 (37.5) |
Selective guidewire insertion across biliary strictures, n (%) | 6/46 (13) |
Kind of procedures | |
Initial examinations, n (%) | 5/6 (83.3) |
Repeated examinations, n (%) | 1/6 (16.7) |
Technical success, n (%) | 6/6 (100) |
Table 6 Safety data of digital single-operator video cholangioscopies in patients with primary sclerosing cholangitis
Variable | Digital SOVCs (n = 46) |
Overall complications, n (%) | 6 (13) |
Pancreatitis, n (%) | 3 (6.5) |
Grade 1 | 0 (0) |
Grade 2 | 2 (4.3) |
Grade 3 | 1 (2.2) |
Cholangitis, n (%) | 3 (6.5) |
Grade 1 | 0 (0) |
Grade 2 | 3 (6.5) |
Grade 3 | 0 (0) |
Others (bleeding/perforation), n (%) | 0 (0) |
Procedure-related mortality, n (%) | 0 (0) |
Suspected prolonged hospital stay due to complications (in days) | 6.5 (± 1.5) |
- Citation: Bokemeyer A, Lenze F, Stoica V, Sensoy TS, Kabar I, Schmidt H, Ullerich H. Digital single-operator video cholangioscopy improves endoscopic management in patients with primary sclerosing cholangitis-a retrospective observational study. World J Gastroenterol 2022; 28(20): 2201-2213
- URL: https://www.wjgnet.com/1007-9327/full/v28/i20/2201.htm
- DOI: https://dx.doi.org/10.3748/wjg.v28.i20.2201