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Abstract
Background and Aims
Indirect diagnostic modalities are unsatisfactory for detecting intraductal neoplasm
of the bile duct (IN-B), which can be detected by peroral cholangioscopy (POC) with
narrow-band imaging (NBI). We investigated the POC findings of IN-B and developed
a feasible endoscopic classification system.
Methods
A total of 471 patients who underwent direct POC from April 2008 to July 2020 were
enrolled. Intraductal superficial lesions of the bile duct (ISL-Bs) were classified
according to surface structure and microvascular pattern on POC with NBI and correlated
to histologic findings after POC-guided forceps biopsy (POC-FB) or surgery. The primary
outcome was the detection rate of IN-Bs, and the secondary outcomes were the associations
of POC findings with IN-B, the technical success rates of POC and POC-FB, and adverse
events (AEs).
Results
Direct POC was successful in 458 of 471 patients (97.2%). Among the patients, 131
(27.8%) exhibited ISL-Bs. The technical success rate of POC-FB was 94.7% (124 of 131).
Among the 124 patients who underwent POC-FB, IN-B was revealed in 54 (43.5%), for
a detection rate of 11.8% (54 of 458). Papillary lesion (P = 0.041), nodular lesion (P = 0.044), and irregularly or regularly dilated and tortuous vessels (P = 0.004; P = 0.006) were POC findings associated with IN-B. The area under the receiver operating
characteristic curve of the novel classification system was 0.899.
Conclusions
POC with NBI can be useful for the detection of IN-Bs. Our novel classification system
based on both surface structure and microvascular pattern may allow differentiation
of IN-B from ISL-Bs.
Keywords
Abbreviations:
AE (adverse event), AUC (area under the receiver operating characteristic curve), CBD (common bile duct), CCA (cholangiocarcinoma), CRM classification (Carlos-Robles Medranda classification), CI (confidence interval), CT (computed tomography), EPBD (endoscopic papillary balloon dilatation), ERCP (endoscopic retrograde cholangiopancreatography), EST (endoscopic sphincterotomy), IN-B (intraductal neoplasm of the bile duct), IPN-B (intraductal papillary neoplasm of the bile duct), ISL-B (intraductal superficial lesion of the bile duct), MRI (magnetic resonance imaging), NBI (narrow-band imaging), POC (peroral cholangioscopy), POC-FB (peroral cholangioscopy-guided forceps biopsy), SOC (single-operator cholangioscopy), WLI (white-light imaging)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
January 1,
2023
Received in revised form:
December 20,
2022
Received:
August 6,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Author contributions
Study concept and design: Jong Ho Moon, Il Sang Shin, Yun Nah Lee
Acquisition of data: Il Sang Shin, Jae Kook Yang, Tae Hoon Lee
Analysis and interpretation of data: Jong Ho Moon, Il Sang Shin, Hee Kyung Kim
Drafting of the manuscript: Il Sang Shin
Critical revision of the manuscript for important intellectual content: Jun Chul Chung, Sang-Woo Cha, Young Deok Cho, Sang-Heum Park
Statistical analysis: Il Sang Shin, Yun Nah Lee
Study supervision: All authors
Approval of the final draft: All authors
Identification
Copyright
© 2023 by the American Society for Gastrointestinal Endoscopy
