Diagnostic application of SpyGlass in indeterminate stricture of hilar bile duct

doi:10.16139/j.1007-9610.2023.04.012

Abstract

Abstract:

Objective: To investigate the diagnostic value of SpyGlass choledochoscopy system in indeterminate stricture of hilar bile duct. Methods: A retrospective analysis was conducted on 146 patients with indeterminate stricture of the hilar bile duct who underwent endoscopic retrograde cholangio-pancreatography (ERCP) and SpyGlass examinations at our hospital between January 2018 and December 2022. The study recorded the visual impressions of the lesions, direct visualization-guided biopsy pathology, and conventional brush cytology results obtained using SpyGlass system. The sensiti-vity, specificity, and accuracy of different diagnostic methods were compared, taking pathological diagnosis as the gold standard and considering long-term follow-up results as well. Results: Out of the 146 patients, the procedure was successful in 145 cases (99.3%). The average procedure time was （51.5±16.9） min. The sensitivity, specificity, and accuracy of SpyGlass visual impression diagnosis for indeterminate biliary stricture were 83%, 84%, and 83%, respectively, outperforming brush cytology results (47%, 100%, and 52%). The combination of visual diagnosis and SpyBite biopsy yielded sensiti-vity of 91%, specificity of 63%, and accuracy of 85%. Adverse events occurred in 24.7% of cases, all of which were clinically mild. Conclusions: SpyGlass choledochoscopy has a high accuracy and safety in differential diagnosis of indeterminate stricture of the hilar bile duct. Its widespread application is warranted.

Key words: Hilar bile duct stricture, Endoscopic retrograde cholangio-pancreatography, SpyGlass, SpyBite

CLC Number:

R657.4

HU Xianrong, YANG Dangdang, WU Jun, ZHAO Yi, CHEN Cui, ZHANG Ting, HU Bing. Diagnostic application of SpyGlass in indeterminate stricture of hilar bile duct[J]. Journal of Surgery Concepts & Practice, 2023, 28(04): 361-365.

Figures/Tables 2

References 15

[1]	KATO H, MATSUMOTO K, OKADA H. Recent advances regarding endoscopic biliary drainage for unresectable malignant hilar biliary obstruction[J]. DEN Open, 2021, 2(1):e33. doi: 10.1002/deo2.v2.1 URL
[2]	ANGSUWATCHARAKON P, KULPATCHARAPONG S, MOON J H, et al. Consensus guidelines on the role of cholangioscopy to diagnose indeterminate biliary stricture[J]. HPB (Oxford), 2022, 24(1):17-29. doi: 10.1016/j.hpb.2021.05.005 URL
[3]	KARAGYOZOV P, BOEVA I, TISHKOV I, et al. Role of digital single-operator cholangioscopy in the diagnosis and treatment of biliary disorders[J]. World J Gastrointest Endosc, 2019, 11(1):31-40. doi: 10.4253/wjge.v11.i1.31 pmid: 30705730
[4]	BISMUTH H, CORLETTE M B. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver[J]. Surg Gynecol Obstet, 1975, 140(2):170-178.
[5]	NAVANEETHAN U, SINGH T, GUTIERREZ N G, et al. Predictors for detection of cancer in patients with indeterminate biliary stricture and atypical cells on endoscopic retrograde brush cytology[J]. J Dig Dis, 2014, 15(5):268-275. doi: 10.1111/cdd.2014.15.issue-5 URL
[6]	SPEER A G, COTTON P B, RUSSELL R C, et al. Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice[J]. Lancet, 1987, 2(8550):57-62. doi: 10.1016/S0140-6736(02)92899-0 URL
[7]	NAVANEETHAN U, NJEI B, LOURDUSAMY V, et al. Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis[J]. Gastrointest Endosc, 2015, 81(1):168-176. doi: 10.1016/j.gie.2014.09.017 pmid: 25440678
[8]	YOON S B, MOON S H, KO S W, et al. Brush cytology,forceps biopsy,or endoscopic ultrasound-guided sampling for diagnosis of bile duct cancer:a meta-analysis[J]. Dig Dis Sci, 2022, 67(7):3284-3297. doi: 10.1007/s10620-021-07138-4
[9]	KULPATCHARAPONG S, PITTAYANON R, KERR S J, et al. Diagnostic performance of digital and video cholangioscopes in patients with suspected malignant biliary strictures: a systematic review and meta-analysis[J]. Surg Endosc, 2022, 36(5):2827-2841. doi: 10.1007/s00464-021-08571-2
[10]	SUN B, MOON J H, CAI Q, et al. Review article: Asia-Pacific consensus recommendations on endoscopic tissue acquisition for biliary strictures[J]. Aliment Pharmacol Ther, 2018, 48(2):138-151. doi: 10.1111/apt.2018.48.issue-2 URL
[11]	DE MOURA E G H. Limited diagnostic accuracy and clinical impact of single-operator peroral cholangioscopy for indeterminate biliary strictures[J]. Endoscopy, 2020, 52(2):90-91. doi: 10.1055/a-1079-3569 pmid: 31991468
[12]	WEN L J, CHEN J H, XU H J, et al. Efficacy and safety of digital single-operator cholangioscopy in the diagnosis of indeterminate biliary strictures by targeted biopsies: a systematic review and meta-analysis[J]. Diagnostics (Basel), 2020, 10(9):666.
[13]	WOO Y S, LEE J K, OH S H, et al. Role of SpyGlass peroral cholangioscopy in the evaluation of indeterminate biliary lesions[J]. Dig Dis Sci, 2014, 59(10):2565-2570. doi: 10.1007/s10620-014-3171-x URL
[14]	TIEU A H, KUMBHARI V, JAKHETE N, et al. Diagnostic and therapeutic utility of SpyGlass(®) peroral cholangioscopy in intraductal biliary disease: single-center, retrospective, cohort study[J]. Dig Endosc, 2015, 27(4):479-485. doi: 10.1111/den.12405 pmid: 25394296
[15]	XIA M X, WANG S P, WU J, et al. The risk of acute cho-langitis after endoscopic stenting for malignant hilar strictures: a large comprehensive study[J]. J Gastroenterol Hepatol, 2020, 35(7):1150-1157. doi: 10.1111/jgh.v35.7 URL

Variable	N	Sensitivity (%)	Specificity (%)	Accuracy(%)	Negative predictive value (%)
SpyGlass visual diagnosis (95% CI)	145	0.83 (0.75-0.89)	0.84 (0.69-0.92)	0.83 (0.77-0.89)	0.63 (0.49-0.75)
SpyBite pathological diagnosis (95% CI)	53	0.58 (0.46-0.69)	1.00 (0.81-1.00)	0.66 (0.56-0.76)	0.36 (0.24-0.51)
Intraductal ultrasound examination (95% CI)	17	0.71 (0.45-0.88)	0.67 (0.21-0.98)	0.71 (0.47-0.87)	0.33 (0.10-0.70)
Cytobrush pathological diagnosis (95% CI)	85	0.47 (0.33-0.61)	1.00 (0.57-1.00)	0.52 (0.39-0.65)	0.17 (0.08-0.35)
Spyglass+SpyBite (95% CI)	53	0.91 (0.82-0.96)	0.63 (0.39-0.82)	0.85 (0.76-0.91)	0.63 (0.39-0.82)