Retrospective Cohort Study
Copyright ©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
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 (%)
Benign18 (81.8)
Malignant4 (18.2)
Localization of dominant stricture, n (%)
Intrahepatic13 (59.1)
Extrahepatic3 (13.6)
Intra- and extrahepatic crossing6 (27.3)
Visual evaluation of stricture by endoscopists, n (%)
Suspicious for malignancy4 (18.2)
Suspicious for benignancy18 (81.8)
SOVC-guided forceps biopsies, n (%)
Carcinoma/high-grade dysplasia2 (9.1)
Benign findings10 (45.5)
Inadequate material1 (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 10 (0)
Grade 22 (4.3)
Grade 31 (2.2)
Cholangitis, n (%)3 (6.5)
Grade 10 (0)
Grade 23 (6.5)
Grade 30 (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)