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Detection and endoscopic classification of intraductal neoplasms of the bile duct by peroral cholangioscopy with narrow-band imaging (with videos)

Published:January 11, 2023DOI:https://doi.org/10.1016/j.gie.2023.01.008
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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)
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