Consensus guidelines on the role of cholangioscopy to diagnose indeterminate biliary stricture
| Autor: | Jong H. Moon, Amit Maydeo, Wiriyaporn Ridtitid, Hsiu-P.O. Wang, Rungsun Rerknimitr, Dong W. Seo, Nonthalee Pausawasdi, Yousuke Nakai, Pham C. Khanh, Ryan Ponnudurai, Hiroyuki Isayama, Christopher Khor, Panida Piyachaturawat, Santi Kulpatcharapong, Thawee Ratanachu-ek, Benedict Devereaux, Phonthep Angsuwatcharakon, James Y.W. Lau, Amol Bapaye, Bing Hu, Mohan Ramchandani, Pradermchai Kongkam, Federick Dy |
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| Rok vydání: | 2022 |
| Předmět: |
medicine.medical_specialty
Consensus Biopsy Constriction Pathologic Malignancy Targeted biopsy Biliary disease 03 medical and health sciences 0302 clinical medicine medicine Humans Cholestasis Hepatology medicine.diagnostic_test business.industry Disease progression Gastroenterology Image enhancement medicine.disease Biliary Tract Surgical Procedures 030220 oncology & carcinogenesis Etiology 030211 gastroenterology & hepatology Radiology Indeterminate business |
| Zdroj: | HPB. 24:17-29 |
| ISSN: | 1365-182X |
| Popis: | Background Indeterminate strictures pose a therapeutic dilemma. In recent years, cholangioscopy has evolved and the availability of cholangioscopy has increased. However, the position of cholangioscopy in the diagnostic algorithm to diagnose malignancy have not been well established. We aim to develop a consensus statement regarding the clinical role of cholangioscopy in the diagnosis of indeterminate biliary strictures. Methods The international experts reviewed the evidence and modified the statements using a three-step modified Delphi method. Each statement achieves consensus when it has at least 80% agreement. Results Nine final statements were formulated. An indeterminate biliary stricture is defined as that of uncertain etiology under imaging or tissue diagnosis. When available, cholangioscopic assessment and guided biopsy during the first round of ERCP may reduce the need to perform multiple procedures. Cholangioscopy are helpful in diagnosing malignant biliary strictures by both direct visualization and targeted biopsy. The absence of disease progression for at least 6 months is supportive of non-malignant etiology. Direct per-oral cholangioscopy provides the largest accessory channel, better image definition, with image enhancement but is technically demanding. Image enhancement during cholangioscopy may increase the diagnostic sensitivity of visual impression of malignant biliary strictures. Cholangioscopic imaging characteristics including tumor vessels, papillary projection, nodular or polypoid mass, and infiltrative lesions are highly suggestive for neoplastic/malignant biliary disease. The risk of cholangioscopy related cholangitis is higher than in standard ERCP, necessitating prophylactic antibiotics and ensuring adequate biliary drainage. Per-oral cholangioscopy may not be the modality of choice in the evaluation of distal biliary strictures due to inherent technical difficulties. Conclusion Evidence supports that cholangioscopy has an adjunct role to abdominal imaging and ERCP tissue acquisition in order to evaluate and diagnose indeterminate biliary strictures. |
| Databáze: | OpenAIRE |
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