Consensus guidelines on the role of cholangioscopy to diagnose indeterminate biliary stricture

Issued Date

2022-01-01

Resource Type

Article

ISSN

1365182X

eISSN

14772574

DOI

10.1016/j.hpb.2021.05.005

Scopus ID

2-s2.0-85108511756

Pubmed ID

34172378

Journal Title

HPB

Volume

24

Issue

1

Start Page

17

End Page

29

Rights Holder(s)

SCOPUS

Bibliographic Citation

HPB Vol.24 No.1 (2022) , 17-29

Suggested Citation

Angsuwatcharakon P. Consensus guidelines on the role of cholangioscopy to diagnose indeterminate biliary stricture. HPB Vol.24 No.1 (2022) , 17-29. 29. doi:10.1016/j.hpb.2021.05.005 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/87445

Title

Consensus guidelines on the role of cholangioscopy to diagnose indeterminate biliary stricture

Author(s)

Angsuwatcharakon P.

Author's Affiliation

Siriraj Hospital
 Juntendo University Graduate School of Medicine
 Duke-NUS Medical School
 National Taiwan University Hospital
 University of Santo Tomas Hospital
 The University of Queensland
 Soonchunhyang University
 The University of Tokyo
 Prince of Wales Hospital Hong Kong
 King Chulalongkorn Memorial Hospital
 Asian Institute of Gastroenterology India
 University of Ulsan College of Medicine
 Rajavithi Hospital
 Faculty of Medicine, Chulalongkorn University
 Deenanath Mangeshkar Hospital & Research Center
 Gleneagles Global Hospital
 Prince Court Medical Centre
 Naval Medical University
 University Medical Center

Other Contributor(s)

Mahidol University

Abstract

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.

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/123456789/87445

Collections

Scopus 2022