INTRODUCTION: Pre-operative histology of bile duct stenosis is associated with low accuracy. Probe confocal laser endomicroscopy (pCLE) enables optical biopsy or in vivo histology. The definitive results of the EMID study are presented here, comparing optical biopsies with definitive histology. AIMS AND METHODS: Sixty one patients with a biliary stricture without any previous histology were included (July 2007-May 2012). An endoscopic ultrasound (EUS) had to be conducted before the ERCP procedure. pCLE was done using CholangioFlex during the ERCP procedure. Results were compared to those of definitive histology obtained by biopsy or surgery in case of malignant lesions, and by surgery or 1-year follow-up in case of benign lesions. RESULTS: Six patients were excluded because no definitive histology was available. There were 41 malignant lesions and 14 benign lesions. Sensitivity, specificity, PPV, NPV, and accuracy with combination of pCLE with endobiliary and EUS biopsies were 100, 71, 91, 100, and 93%, respectively (with a significant increase of accuracy compared with endobiliary and EUS biopsies without pCLE, p = 0.03). 19 patients had a biliary stricture without individualized mass (6 malignant lesions, 13 benign lesions). Sensitivity, specificity, PPV, NPV, and accuracy for pCLE were 83, 77, 62, 91, and 79%, respectively. Sensitivity, specificity, PPV, NPV, and accuracy for combination of pCLE with endobiliary and EUS biopsies were 100, 69, 60, 100, and 79%, respectively. CONCLUSION: The addition of a pCLE procedure in the diagnostic histologic examination of a biliary stricture permits a significant increase in diagnostic reliability and allows for a VPN of 100%.
INTRODUCTION: Pre-operative histology of bile duct stenosis is associated with low accuracy. Probe confocal laser endomicroscopy (pCLE) enables optical biopsy or in vivo histology. The definitive results of the EMID study are presented here, comparing optical biopsies with definitive histology. AIMS AND METHODS: Sixty one patients with a biliary stricture without any previous histology were included (July 2007-May 2012). An endoscopic ultrasound (EUS) had to be conducted before the ERCP procedure. pCLE was done using CholangioFlex during the ERCP procedure. Results were compared to those of definitive histology obtained by biopsy or surgery in case of malignant lesions, and by surgery or 1-year follow-up in case of benign lesions. RESULTS: Six patients were excluded because no definitive histology was available. There were 41 malignant lesions and 14 benign lesions. Sensitivity, specificity, PPV, NPV, and accuracy with combination of pCLE with endobiliary and EUS biopsies were 100, 71, 91, 100, and 93%, respectively (with a significant increase of accuracy compared with endobiliary and EUS biopsies without pCLE, p = 0.03). 19 patients had a biliary stricture without individualized mass (6 malignant lesions, 13 benign lesions). Sensitivity, specificity, PPV, NPV, and accuracy for pCLE were 83, 77, 62, 91, and 79%, respectively. Sensitivity, specificity, PPV, NPV, and accuracy for combination of pCLE with endobiliary and EUS biopsies were 100, 69, 60, 100, and 79%, respectively. CONCLUSION: The addition of a pCLE procedure in the diagnostic histologic examination of a biliary stricture permits a significant increase in diagnostic reliability and allows for a VPN of 100%.
Authors: Mario de Bellis; Stuart Sherman; Evan L Fogel; Harvey Cramer; John Chappo; Lee McHenry; James L Watkins; Glen A Lehman Journal: Gastrointest Endosc Date: 2002-11 Impact factor: 9.427
Authors: Alexander Meining; Yang K Chen; Douglas Pleskow; Peter Stevens; Raj J Shah; Ram Chuttani; Joel Michalek; Adam Slivka Journal: Gastrointest Endosc Date: 2011-07-29 Impact factor: 9.427
Authors: P C Verbeek; D J van Leeuwen; L T de Wit; J W Reeders; N J Smits; A Bosma; K Huibregtse; M N van der Heyde Journal: Surgery Date: 1992-11 Impact factor: 3.982
Authors: Alexander Meining; Eckart Frimberger; Valentin Becker; Stefan Von Delius; Claus Hann Von Weyhern; Roland M Schmid; Christian Prinz Journal: Clin Gastroenterol Hepatol Date: 2008-07-17 Impact factor: 11.382
Authors: Horacio J Asbun; Kevin Conlon; Laureano Fernandez-Cruz; Helmut Friess; Shailesh V Shrikhande; Mustapha Adham; Claudio Bassi; Maximilian Bockhorn; Markus Büchler; Richard M Charnley; Christos Dervenis; Abe Fingerhutt; Dirk J Gouma; Werner Hartwig; Clem Imrie; Jakob R Izbicki; Keith D Lillemoe; Miroslav Milicevic; Marco Montorsi; John P Neoptolemos; Aken A Sandberg; Michael Sarr; Charles Vollmer; Charles J Yeo; L William Traverso Journal: Surgery Date: 2014-01-02 Impact factor: 3.982
Authors: M J van Heerde; K Biermann; P E Zondervan; G Kazemier; C H J van Eijck; C Pek; E J Kuipers; H R van Buuren Journal: Dig Dis Sci Date: 2012-05-16 Impact factor: 3.199
Authors: Shadi S Yarandi; Thomas Runge; Lei Wang; Zhijian Liu; Yueping Jiang; Saurabh Chawla; Kevin E Woods; Steven Keilin; Field F Willingham; Hong Xu; Qiang Cai Journal: Diagn Ther Endosc Date: 2014-06-05
Authors: Fabrice Caillol; Erwan Bories; Christophe Zemmour; Christian Pesenti; Jean Philippe Ratone; Marine Gilabert; Simon Launay; Marc Giovannini Journal: United European Gastroenterol J Date: 2018-09-27 Impact factor: 4.623
Authors: Alessandro Fugazza; Federica Gaiani; Maria Clotilde Carra; Francesco Brunetti; Michaël Lévy; Iradj Sobhani; Daniel Azoulay; Fausto Catena; Gian Luigi de'Angelis; Nicola de'Angelis Journal: Biomed Res Int Date: 2016-02-17 Impact factor: 3.411
Authors: Sabine Zirlik; Kai Hildner; Ralf Joachim Rieker; Michael Vieth; Markus Friedrich Neurath; Florian Siegfried Fuchs Journal: Med Sci Monit Date: 2018-08-05